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APi�LICATIC 1 FOR CONSTRUCT )N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING �YSTEM: ❑ GAS ❑ ELECTRIC 0 <br />BUILDING DEPARTMENT <br />59 8810 <br />2 - <br />I! DEMOUTION ! COMBINATION BUILDING � MECHANICAL i' PLUMBING l! SIGN <br />OWNER �MAILA��RE55 CITY 21P PdONE <br />Kc'hhe� ��r�s'�9� 2`E-0l �tu��i�TEo 6LUQ ��cv�f} c�.1�t `�BLa3 23S CSZ`� <br />TENANT <br />MPIL AD�RESS CITY 21P PHONE <br />��n, Z�p PHONE <br />ARCHITECTORDESIGNER MAILADDRESS <br />CITY ZIP Ph�NE STFTELICENSEI <br />GENERRLCONTRACTOH MAILAD�RESS <br />��T� Z�p PHONE STA7E LICENSE � <br />MdCHANICALCONTRACTOR MAILADDRESS <br />���, Z�p PHONE STRTEIICENSE� <br />PLUMBINGCONTRACTOR MAIL4DDRE55 <br />NEW I I ADDITION '� I ALTERATION <br />SOUARE <br />USE OF BUILDING <br />IEGAL DESCRIPTION OF PROPERTY (SNOWN �ELOW OF <br />LOT BLOCN �F — <br />2`/0! I�1Jk77EU BLV� <br />PRQIECT ADDRE55 <br />I REPAIR i I DEMOLITION ��' WOODSTOVEIFRPLINSERT <br />� CONTACT PERSON AND PHONE NO. <br />FOUR <br />� <br />NO. � YPE OF FIXTURE OR ITEM FEE <br />WATER�LOSET(TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />FOR OFFICE USE ONLY: <br />cvnurcornar.K REAR; <br />ZONE <br />OF LONiS.I <br />OF BLDG. <br />��UPANCY L� <br />SON FOR : <br />1NE BY <br />LOT AREN <br />7YPE OF CON51. ACIUAL <br />NO. OF STOHIES <br />FIRE SPRNKLERS REO'D <br />vi eus APPROVE� BV <br />SIUE SETBACK <br />� BUILDING RELOCATION <br />I HEflEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNO1N THE SAME TO BE TRUE AND CORRECT. ALL <br />PRO�ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETl1ER SPECIFIED HEREIN OR <br />NOT. THE 3RANTING OF A PERMIT DOES �OT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OP CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTICN OR THE <br />PERFORMANCE OF CONS7RUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CO'.IPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />�__ �/u(�z _ <br />SIGNAIUiIC OAiE <br />FEE <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />i INIT NFATERS—B.T.U. M <br />lERS <br />� <br />FAN <br />I <br />METAL FIREPLACE 8 <br />GAS <br />BUILOING <br />acu>excv xoaownuxcuxrts <br />taour ' pLUMBING <br />BTSEMEN7 MECHANICAL <br />NEIGNT LIMITATION ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC\VORKS <br />LOCAL SALES <br />TAX CODE IS 3105 T�T�� <br />FEE <br />S <br />� <br />� <br />♦ <br />'-> <br />