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,t APPLICATIC ] FOR CONSTRUCT _ �N PERMIT ��� <br />r '�•✓�Jrsn <br />, TO BE COMPLETED IN BLACK INK—PLEASE PRINT �� <br />HEATING SYSTEM: C.1 GAS ❑ ELECTRIC J. � <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDIN . MECHbNICAL PLUMBING SIGN <br />CITv iIP PMONE <br />� �y <br />qp M <br />Y«{�IN <br />~ i Mfff��� <br />O M � <br />0! M <br />� � � <br />H � <br />�, � <br />CN <br />M <br />N <br />N <br />O V1 <br />e� rtq <br />O N <br />OWNER MA�LPDDRESS <br />l��lrTl �2 �ti " �' '� i 3i a�r i�ce F� ar�ati . . .v- -�-1 �.� i - 7�i�? <br />�ENANT UAILADDRE55 CITY ZIP PNONE <br />MIiC� k4.� i�7 �ik�R�Sc�N' AJt� E�' �'if=1'�t 2�h^f-7.�J4-Ef <br />a9CNITEGTORDE5IGNER MARADDRE55 CItY ZIP P110NE <br />GCNEFRLCAHTRACTOR MARAODRESS CiTV 21P PMONE STATEUGENSE� <br />/ <br />CLASSOFWORN Mi�C2 `�!�� n � � � <br />NEW ADDITION � AITERAT10N X REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />I CONIACT P[RSON ANO PNONE NO. <br />CONTFALT PRiCE OF WORK °,j� OU V <br />�[SCPiBE WORN AND SOUARE FOOTAGE INVOlVcO <br />RCS'JiiR F-1RC UAMAc G TO _� <br />vROP05[D USE OF BUILDiNG <br />r. Y�sr SFfZ <br />l[ WL �[SLRIPTIpN OF PROPERTV ISNOWN BELOY <br />LOT�_ BtOCK r,c . -a�?DF <br />PnOJ[crADDRE55 <br />� �I% i�h�%��r�J Au G <br />PLUMBING <br />NO. TYPE OF FI%TURE GR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KIl CHEN SINK 8 DISP <br />DISHWASHER <br />�AUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADEF <br />SINK (SERVICE—BAR. ETC.) <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN RERR SETBACK <br />LOTAREA <br />LVP[OfLONiS.AIIOWABLf 1rvtU� <br />SIZE OF BLDG. NO.OF <br />OCCUPANGYLOAp <br />REASON FOR SPPIi <br />INTAKE BV <br />i HE(iEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />onnrincNvouacoaiesi PROCISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETIIER SPECIFIED HEREIN OR <br />CJ�R' NOT. THE GRANTING Cr A PERMIT DOES NOT PRES�IME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAJJ REGULATING CONSTRUCTION OR THE <br />PERFORtAANCE OF CONSTRUCTION. THAT I Ald AUTHORIZE� BY THE <br />OWNER OF THIS PROPERTY 70 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CO':�PLY WITH THE STAtE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAG. <br />/ �,'i <br />i <br />i� Jl/� •11��/C/�e �� � i�.G"G-. ^JL <br />� .u��c - :% c.�F. <br />SUB TOTAL S <br />PERMIT 5 _ <br />TOTALFEE 5 <br />SID� SETBAC <br />VAC 1Nt SITE <br />CONSi.AC1UAl I occuo�xn I x0ortw[uMGuxai <br />LPyJV <br />FIRE SVRNNlER5PE0D <br />PLANS PPPROVEO BY <br />9ASEMENT <br />LIMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />CU2 <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGE HOOD __ <br />METAL FIREPL <br />FIREPLACE IN; <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />NUTAB[R <br />BUILUING <br />PLUMOING <br />MECNANICAL <br />ADDITIONAL P.AN CHECK <br />SPRINNLER <br />STATE OUILDING SURCHARGE <br />PUBLIC WORYS <br />TOTAL <br />PERMIT <br />