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APPLICATIC A FOR CONSTRUCn. N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT �w <br />BUILDING DEPARTMENT `- <br />259-8810 <br />I ! DEMOLITION COMBINATION <br />OWNER MAIL <br />tIAjV <br />ANT MAIL <br />HEATING SYSTEM: JtAS ❑ ELECTRIC O I <br />Vd <br />11LDING MECHANICAL PLUMBING I I SIGN <br />CITY ZIP PHONE <br />EDMONM 9S0?0 454 -571 I <br />CITY ZIP PHONE <br />AACHIiECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />CITY ZIP PHONE <br />STATE LICENSE t <br />GENERAL CONTRACTORp <br />MAIL ADDRESS <br />4 6,> / _0 e_ <br />CIT, Zlp PHONE <br />STATE LICENSE I <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CLASS OF WORK <br />DEMOLITION i I WOODSTOVE/FRPL INSERT <br />BUILDING RELOCATION <br />I I NEW ADDITION <br />I ALTERATION <br />REPAIR <br />CONTACT PERSON AND PHONE NO. <br />Aon ✓E <br />DESCRIBE WORK AND SQUARE FOUTAGt invNxvcN - - Rp Nbq <br />EDwAAwr WITH <br />PROPOSED USE OF BUILDING <br />w_$jD6PICE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT 11j A BLOCK OF <br />TIKC ay1 'VOL-8 FARM 3 - <br />Du <br />SINK <br />DRAIN <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA 8.27 RCW ANDA96.200 WAC. p <br />SDA.E <br />AT E <br />NO. <br />CED AIR SYSTEMS-B.T.U. <br />'r I IAIIT HEATERS-B.T.U. M <br />FAN 1 <br />WATER HEATER <br />WOOD STOVE <br />HEAT PUMP <br />GAS PIPING <br />PERMIT <br />$ <br />PERMIT <br />$ <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />$ <br />FOR OFFICE USE ONLY: <br />FEE <br />RECEIPT NO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />�?8 Q <br />FEES <br />VALUATION <br />FEE <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />:00 <br />BUILDING <br />O <br />TYPE OF�CO•NTS. ALLOWABLE <br />TYPE OFFCCONNST. ACTUAL <br />yr NO Of MtLUNG UNITSOU <br />PLUMBING <br />f. <br />--- <br />}L- <br />x-� <br />SIZE OF BLDG. <br />NO,. OF STORIES <br />BASEMENT <br />MECHANICAL <br />STL <br />O <br />ADDITIONAL PLAN CHECK <br />9 <br />i%1I <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS REO'D <br />HEIGHT LIMITATION <br />i <br />N O <br />SPRINKLER <br />—T <br />S� <br />PERSON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />INTAKE BY <br />LOCAL SALES <br />3 <br />._ L <br />TAX CODE IS 3105 <br />TOTAL <br />) <br />