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`�30�7 <br />APPLICATIC�I FOR CONSTRUCTr)N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8610 <br />❑ DEMOLITION ❑ COMBINA110N <br />n IAAIL ADDRE55 <br />S <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ _ <br />❑ BUILDING J�( <br />CITY 1 '-ZIP <br />❑ PLUMBING ❑ SIGN <br />.3ss - 6 ��/� <br />TENANT MAII AD�RE55 CITY ZIP PHONE <br />ARCHITECTOFOESIGNEF MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADURE55 CITY 21P PHONE STATE LICENSE � <br />N.I7 <br />..__... ..... ennoGcc . CITY , /11� � � PNONE STATELICENSF� � Rn <br />�Q'SC) i�..�'i9i.�rf %` � <br />pONTFACTOR MRILpDDRE55 <br />: OF WORI( ,I„ s <br />3 d /O ••• <br />�. <br />�ND SOURRE FODT�GE INVOLVED <br />LEGAI DESCRIPTION OF PROPE <br />l0T BLOCK <br />PARCELTA%LD,NUMBEF <br />CONSTRUCTION LOAN LE! <br />CITV ZIP PMONE <br />CONTACT PERS�N AND PHONE NO. <br />. <br />_n 7c'9 <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAMF TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES CaOVERNING THIS TYPE OF <br />�SMOIMBELOWORA7IACHTWOCOPIES� NOT. THELGRANTOING OF AD ERMITJDO SENOT PRIESUME TO GIOVE <br />oF AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGJLATING 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 />C HS LAW 18.27 CW AND 296200 WAC. <br />IRE55, TELEPHONE NUMBER /� (a'� <br />/ <br />$IGN�TUflE OATE <br />�oohess`7�ts mD1�!'C� <br />O <br />i1N(i <br />TYPE OF fl)(TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) _ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />USE ZONE <br />TYPE OF C01!5T <br />SIZE OF BLDG. <br />OCCUPANLYLOAD <br />RERSON <br />INTANE BY <br />LOT AflER <br />FIRE SPRINNL"cR5 REO'D <br />FIRE ALARM HEOD <br />PUNS FPPROVED BY <br />SETBACN <br />FORCFD AIR SYSTEMS—B.T.U. M E.A. <br />I INIT NFATERS—B.T.U. M <br />RANGEHOOD <br />WATER HEATE <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHECK NUMBER I FEE <br />VPCANT SITE rcw <br />❑ YES � ND BUILDING <br />o:cur.�r rrooro•xrwxcuxus <br />enwv PLUMBING <br />BaSEMENT MECHANICAL <br />❑ YES ❑ NO <br />IIEIGMT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETi PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />Ej <br />FEE <br />ao <br />M <br />�N <br />C <br />DATE TAX CODE IS 3105 TOT�� � <br />L <br />