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APPLICATIO ' FOR CONSTRUCT( �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: � GAS 'J ELECTRIC J <br />BUILDING DEPARTMENT — <br />259-8810 <br />' DEMOLITION COMBINATION BUILDING I' MECHANICAL ' I PLUMBING 1 SIGN <br />OWNER MAIL ADDRESS CITV IIP PMON[ <br />�,acy sr��� i z� o,���� AUF. � s� zo� zsz - s�s <br />TENANT MNLApOFE55 CITY ZIP PHONE <br />DESIGNER <br />GENEF4LGONTPACTOF MFILADDRESS <br />CIiY <br />GTY ZIP <br />PHONE <br />PNONE STATE LICENSE Y <br />MECNANICAL CONTflACTOR MAIL AODRE55 GITY ZIP PIIONE STRTE LiCENSE • <br />r. F .�,9 u - <br />PLLIMBINGCONTqACTOR MAILAODRE55 CITY ZIP PHONE STATELICENSER <br />CONTRAGT PRICE OL WORK <br />WORK ANO SOUARE FOOTAGE INVOIVED <br />PROPOSED USE OP BUIL�ING <br />��� <br />IEGAL DESCRIPTION OF PROPE <br />�or oiocn <br />ISHOWN BELOW OR ATTRCH T WO COPIESI <br />OF <br />PARCELTA%ID NUMBER <br />CONSTpUCT10N1.OPNLENOLR.ADORESS,TELEPHONE <br />PLUMBING <br />O. TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY <br />SHOWER <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR. ETC <br />FOR OFFICE USE ONLY: <br />FRONTSETBFCN PEARSETBAC1c <br />USE 20NE <br />TYPE Of CON57 <br />52E Oi BLDG <br />O(:CUPANGY LO�D <br />FEASON <br />MT4NE BV <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />IOTAREF <br />NO OF STORI[5 <br />FIRE SPRINNLERS REO'D <br />FlR[ AIARid fiEO'� <br />PLANS APPROVED BY <br />oniF. <br />SIDE SETAACK <br />CONT4CT PERSON �ND FMONE NO. <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FROVISIONS 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 PRESUM[ TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR i HE <br />PERFOFi61ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATiON IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />,��Oii'A'' 6-/3- 9y <br />sicrv mnc ouc <br />Gliv flUSM[55 LiCU:54 rv0 <br />AIC—AMNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTII.ATION FAN <br />RANCEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD 8UF <br />� FIREPLACE INSERT <br />� HEATPUMP <br />; GAS PIPING <br />EXHAUST FAN <br />V�CANT SITE <br />;—. YES . � NO <br />acu�.un r�ac�mrmrvo��xas <br />GNOUP <br />BASEM[NT <br />.-�. YES � �. NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />FEE <br />: i <br />FEE S I :i� : � <br />�u�ea/ I ree I �ECEIPTNO <br />/' <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDIiIONAL PLAN CNECK <br />OTHER <br />SiATE BUILDING SURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />