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APPLICATII A FOR CONSTRUCT _ON PERMIT C� <br />TO BE COMPLETED IN BLACK INn—PLEASE PRINT <br />HEATINGSYSTEM: GAS <br />UELECTRIC <br />O <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />COMBINATION <br />BUILDING <br />Y MECHANICAL <br />PLUMBING SIGN <br />ONNER <br />MAE ADDRESS <br />CrtY <br />av <br />PHONE <br />0AT[ L.IFAI SbAU`c <br />EFyL.eA <br />�oa�' Il <br />lc�tr�to-� (i} <br />/ <br />[/(/��(]L���a- <br />l�/5 <br />TENANT <br />MAI ALORE55 <br />GR <br />ZW <br />PHdIE <br />ARCNITECI OR DESIGNER <br />WIL ADDRESS <br />CCV <br />ZIP <br />MNE <br />GENEIMLCCHTFACTOR <br />MAE ADDRESS <br />CITY <br />ZP <br />PNGIIE <br />STATE LICENSE <br />. ANCAL CONTPACTOR <br />15,_j5 <br />"It ADDRESS <br />CRY <br />ZIP <br />PHONE <br />STATELCENSEA <br />E:v-1 uEAnivb <br />/0�/e <br />5:5& Alf &,� <br />cl.075' <br />453-33Yy <br />PIINIBNG CONTPACTOR <br />Mt ADDRESS <br />CITY <br />ZIP <br />MCOIIE <br />STATE LGENSCF <br />CUSS CIF NCRK <br />i ' NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />�1 '` <br />Cd1TRAtl PPICE CF WOIIK yc ) <br />C011TACT PER5CN AND 1IGNE NO <br />pE$LPIBEYHXM AND SOII//ARE fMITAOE(N�v`0.VE0 <br />�AKS�Y�� [.AnS 116a� <br />PROPoSEDV BUILDNS <br />I HEREBY 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 PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />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 />CONTRACTOR;, LAW 18.27 RCW AND 296.2DO WAC. <br />x l_I e _ %-(- 9� <br />LEGAL DESCRIPTCN GP PROPERTY ISHOP.tl SELMER ATEACH EMIR COPIES) <br />LOT eLocK OF <br />PROTECT ADDRESS <br />EKN,*LPL n ,r. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A C—A HNDLG UNITS—H P <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHESORYERS <br />KITCHEN SINK $ DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />'J <br />TOTAL FEE E <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY- <br />FBo11TSETWK <br />REARSETRACK <br />SIDE SETBACK <br />PUN CNECK MINDER <br />lg <br />PEE <br />RECEIPT%C <br />USEZCNE <br />LOT AREA <br />VACMRSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />IYR of COPIES WMAKE <br />EYPE M=5T ALTOK <br />RT.IAAAL� ptlPAFUAt INn <br />,.P, <br />PLUMBING <br />SIZEOFBLGO <br />NO OFSTWffS <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />MCURANOY LCA) FIRE SPR URS REM NEGniIMRATCN <br />PUSONFORSPRNKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />NTAKEBY <br />PLANS APPRAOL4U BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />Pu6uc WORKS <br />TOTAL <br />