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APPLICATIC�1 FOR CONSTRUCT'lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTtiIENT � HEATING SYSTEM: ❑ GAS �ELECTflIC ❑ —� <br />259-8810 <br />Cl DEMOLITION � COMBINATION f.I BUILDING Ll MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRE55 CITV ZIP PMONE <br />�FlwRF N�(,-' /✓<16.(�AGN 'L� 3'�{u6ii vho 9cE t vr..c�iT' 9 SLo � zS�—�y�-a <br />TENANT MRILADDFE55 GTY 21P <br />PHONE <br />ARCHITECTORDESIGNER MRILADORESS CITV ZIP PHONE <br />GENERAL CONTRqCTOR MAIL A�ORESS CITY ZIP PHONE STATE UCENSE 1 <br />NA��n�r� l,oN.fr z13L H�LHLAtip A�,(.' tv��1=T 9gui i51-7Ys'o N9�6.9c �} 23�oy <br />MECNANICAL CONTRACTOR lAAIL pDDPE55 CITY ZIP PHONE STATE LICENSE n <br />PLUMBING CONTRACTOF MAIL ADORESS CITV ZIP PHONE STATE LICFNSE t <br />Pn�E Q1=�r�ES 3Yli ►cRor,C,¢ E�ER,�y�' ��8�� 59-i9�� A.s��ssi� 6s B� <br />CONTRqGT PRICE OF WOPK „ <br />OESCRIBE WORK �ND SQURRE <br />k� <br />�4e u�� <br />PROPOSED USE OF BUILDING <br />s <br />LEGAL DESCflIPTION OF PROPERN (SHOWN BELOW OR AT7ACH TWOCOPIES) <br />��T� BLOCK � OF Pl � T U F <br />PAflCELTAXI.D.NUMBER <br />'f3�1-G� -vll-oac3 <br />CONSTRUCTION LOPN LEND�R. ADDRESS, TELEPHONE NUM9ER <br />A►,F..ai y.- Fi,PST 26v L f�a.,np�.Yl v <br />PHOJECTADDRESS <br />2q i9 Nn�� �v <br />PLUMBING <br />� N0. TYpE OF FlXTURE OR REM <br />WATER CLOSET (TUILET) <br />� BATHTUB <br />� LAVATORY (WASH BASIN) <br />SHOWER <br />I KITCHEN SINK 8 DISP - <br />� DISHWASHER <br />LAUNDFYTRAY <br />CLOTHES WASH�R <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BAGKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEADERS <br />SINK (SERVICE—BAFi, ETC.) <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE S <br />POR OFFICE USE ONLY: <br />FRONT�CK� REAR SETBACN <br />USG NF. LOTARE� <br />1YPEOiC0y5T.) NO.OFSTORIES <br />!r J <br />SIZEOFBLDG. FIRESPRINKLERSREOD <br />S � � <br />OCCUPANCY LOAD FIRE ALARM PEO'D <br />►J /ti nl o <br />INTANE BY � PL1N5 APPPOVEO BY <br />DATC C.// Z' <br />S3-lL <br />CONTACTPERSONANDPHONENO. L�RRY <br />L.,'1- <br />i HEREBV 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 PERM�T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STAIE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPFRTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br />V \ � <br />s�cr+uune .�� �.3 o�re Y. / y 9 Y <br />cin eusrvcss ucer�se rro <br />FEE N0. TYPE OF EOUIPMENT FEE <br />� AIC—A/HNDLG UNITS-H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATERS--B.T.U. M <br />! I CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE <br />FIREPLACE INSER' <br />HEAT PUMP <br />GAS PIPING <br />PLAN CNECK NUMBER <br />VACANT SITE FEES <br />❑ YES J NO BUiLDiNG <br />OCCOMYLY NOOfQ0.ttUNGUNiiS -- <br />p0� I PLUMBING <br />BASEMENT � � MECHANICAL <br />❑ YES �!NO <br />NEIGHT LIMITpTI� ADOITIONAL PLAPI CIIECK <br />� OTHEF <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 T�TA� <br />SUB TOTAI $ <br />PERMIT 5 <br />FEE/�/�� <br />d <br />