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APPLICATIC�I FOR CONSTRUCTr�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMEtJT <br />259•8810 / <br />� DEMOLITION I 1 COMBINATION �✓ BUILDING I 1 MECHANICAL f! PLUMBING 1 SIGN <br />OWNER MAILADDRESS CITY 21P PHONE <br />�A�InE1t�N �Ef�( 2�03 f�r�nl�E2- RVE�, E��rr, ura • 9gz.oi s88-oia3 <br />TEA�N7 M�ILAUORE55 CITY ZIP PHONE <br />ARCHITECTOR�ES�GNEF MAILA�ORESS CITV 21P PMOKE <br />GENERALCONTRFCTOR MFILADORE55 CITV 21P Z 0 PHON[ STATELICENSE> <br />S�Ns�f OEcf_5/�16TZEc.Co�J572 9cny i�b�sr, S�lotb WA. 668�84�7 IuET�ECr0�3D9_ <br />MECHANICAL CONiR�CTOR MAIL ADDRE55 C17V ZIP PHONE STATE LICENSE e <br />.11a 'A�� I � — <br />PWMBIYG <br />CON7FACT ARI('� OF \YORK <br />MAIL ADURESS <br />� <br />citv zm <br />� 1^ I CONTA E <br />�IIVY <br />PNONE STATE LICENSE e <br />j,ANDfI�b u�l'ikF fJEvJ STR1Rl�A`1 RND DE�K- <br />R'r 'Z(JD 5�o�y. FM(IioK W F'%�' IS� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOGED USE OF B i iuc c( APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />- /L� $/ E�t1TiA[_ �r PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYP[ OF <br />LEGAq �ESLRIPTIONOFPR PER ISNOWNBELOWORATTAGNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />Lor�/7.�Vtl� (.�f BL�N [�4� aF �)AP�� (,���� (}{�u�T� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />-tf—„ar„r�t AUTHORITY TO VIOLATE OR CANCEL TH[ PROVISIONS OF ANY <br />T� �� `� � 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 />P�RCEL TAX I D NUJMBtE/R/ �7 CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />� �S "�lTZ �QZ — �U� I <br />CONSTRVGTION LO�N LEN/��ER. �DORESS, TELEPHONE NUMBER �_ ^� ' {� _r��j/J�� Q7_'^ �� <br />1� rT X r irn rn i� � j f�P // csr- <br />U„W v 'i—i1--x�—' oe�c <br />PROJECT ADDR SS sicv.mae u <br />y103 RArnffE2 M!� �IE2E'fi' ���������Es���=��s��� <br />NO. TYPE OF FI%TURE OR ITEM <br />BATHTUB <br />�AVATORY(WA <br />SHOWER <br />KITCHEN SINK <br />DISHWASHER <br />LAUNDRYTRA' <br />CLOTHES NA£ <br />URINAL <br />DRINKING FOl <br />FLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAINS <br />0 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSET <br />��% Z <br />US6 ZONE LOT AREA <br />, -Z d <br />iYPE OF CONSi NO OF ST <br />SIZE OF BLDG <br />�5p� f <br />OCCUPANCVLOAD <br />__L( 'L <br />REASON <br />MTAKE BY <br />FEE <br />0 <br />MECHANICAL <br />�O. TYPE <br />SUB TOTAL 5 ;� <br />PERMIT S <br />TOTAL FEE S <br />, SIDE SETBACK P�AN <br />S / <br />FIRE SPRINNLERS REO'D <br />�J <br />FIRE �L�RM REO D <br />PLnNSAPPROVED�Y <br />DATE <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T,U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BUI <br />FIREPLACE INSERT <br />HEAT PUMP _ <br />GAS PIPING <br />EXHAUSTFAN <br />VACANT $ITE �cco <br />.- YES � N� BUILDING <br />xcuP��rcY uoo�o�atwneoxns <br />�"a'° f PLUMBING <br />BaSEn�ENi MECHANICAL <br />' YES f�0 <br />HEIGHT LIMITATI � ADDITIbNAL PLAN CHECK <br />OTHER <br />STATE OUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TJTA� <br />FEE <br />E.A. <br />SUBTOTAL 5 _ <br />PERMIT 5 � <br />TOTAL FEE 5 <br />RECEIPT N0. <br />S i� <br />VALUATION FEE <br />25�5 =y�oo <br />i <br />i <br />�� . <br />i <br />i <br />i <br />i <br />� i a_� <br />� � <br />J �� �— ,- <br />