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APPLICATIO► � FOR CONSTRUCTI'' 1�1 PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT L <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />�p F1L L1�uvG� ,L Eoo7 H� <br />TENANT M�ILADDRESS <br />HEATING SYSTEM: <br />❑ BUILDING <br />cirr <br />� vrEk� c�v. <br />❑ ELECTRIC ❑ <br />L7'MECHANICAL <br />ZIP q <br />21P <br />O PLUMBING ❑ SIGN <br />3a3 -q��o3 <br />nncMITECTIXiDE51GNER 'IAILADDAE55 CITY ZIP PIIONE <br />OENEMLCOryTRpG7pp MAILADORE55 CITY 2IP PNONE STATELICENSEI <br />MELMANIC11LCpf�7q�CTOR M�ILADDRE55 qry Zlp p�qNE Sf�TELICENSE� <br />AU�RE55 <br />AND SOUME fOOTAGE INVOLVED <br />USE OF BUILDING <br />LE WL DESCflIPT10N OF PROPEflTY ISHOWH BELOW OP ATTACN M�O COPIESI <br />LOT gLpCK pF <br />PARCELTiU(I.D.NUMBEfl <br />CONSTRUCTIONLWNLENDE? ADDRESS.TELEPMONE <br />KITCHEN SINK 8 DISP <br />DiSHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTi <br />ROOF DRAINS—RAINL <br />SINK (SERVICE—BAR. <br />FOR OFFlCE USE ONLY: <br />FRONTSETBACK REAR! <br />ttPF OF CONST. <br />SIZE OF BLDG. <br />OCCUPANCYLOAO <br />PEASON <br />INT�KE BY <br />r <br />NO.OF STORIES <br />FIRE SPRINKLERS REO'D <br />FIRE AL�RM REO'U <br />PUNS �FPROVED BV <br />ORTE <br />FEE <br />F7 <br />SIDE SETBACI( <br />ZIP <br />CpNTAGT PERSON AND PHONE N0. <br />Si�TE LICENif I <br />1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM TME WORK FOR WNICH <br />APPLICATION IS MADE AND I C MPLV yJITH TI1E STATE <br />CONTRACTORS UW 1827 RC W AND 2:200 NMb. <br />a�aHNo�c <br />FORCED AIR S <br />UNIT HEATERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE <br />FIREPLACE INSER' <br />HEAT PUMP <br />GAS PIPING <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />OCCUVLVCv Iq OfpW[LIIMGUNifS � <br />4R0°P PLUMBING <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGnTLIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT pUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />bM <br />O <br />� <br />