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APPLICATIC^1 FOR CONSTRUCT'1N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION i-', COMBINATION !' BUfLDING i MECHANICAL 1- PLUMBING I 1 SIGN <br />O`MdER MAIL AD 55 CITY ZIP PHONE <br />li�.'a�snzrc�..k, �ZS`.�o�% �' ���� L=�"�:z� `j"��`'1 �25�.2 -(G �9c� <br />iFNANT MAILApDRE55 div ZIP PHONE <br />ARCHIiEC70RDE51GNER MAILADDFE55 <br />GENERALCONTPACTOR MAILADDRESS <br />GTV <br />ZIP PNONE <br />STAiE UCENSE � <br />MEGHANICAL LONTRACTOR MAIL ADORE55 CITY ZIP PHONE STATE LICENSE t <br />PLUMBING CONTRACTOR MAIL ADDRESS QTV ZIP PHONE STATE LICENSE � <br />CONTRAGT PRICE OF WORK <br />OESCFIBE WORK AND SOU�RE fOOTAGE INVOIVED <br />PPOPOSED USE OF BUILDING <br />LEWL DESCRIPTION OF PROPERTY ISMOWN BELOW OR ATTACN TWO COPIES� <br />LOT BLOGN OF <br />�p�I10EL TA% ID. NUMBER <br />vV <br />CONSTRUGiION LO�N LE1 <br />pER,ADDRF55.TElEPHONE NU� <br />- ��a 3 - .na 3 - <br />SHOWER �J <br />KITCHEN SINK 8 DISP I <br />UISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />�i00F DRAINS—RAINLEAGERS _ <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />FON OFFICE USE ONLY: <br />FRONT SETBRLK REAP SETBACK <br />USE 20NE <br />TVPE OF CONST. <br />SIZE OF BIDG. <br />OI:CUPANCV L <br />REASON <br />INTAKE BV <br />LOT AFER <br />FlRE SPRINKIERS REO'D <br />FIRE <br />DFTE <br />SIDE SETBACN <br />0 <br />CONTACT PERSON RN� PNONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PIUVISIONS 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 />PERFOflMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION I �1ADE AND I COMPIY WITH THE STATE <br />CONTRACTORS Al� 18.27 RCW AN 96.200 WAC. <br />� <br />� 3 �9 <br />S�G HE G�IE <br />NO. I TYPE OF <br />FOFCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HE4TER <br />WOOD STO'/E <br />METAL FIFEPUICE ( <br />FIREPLACE iNSERT <br />HEAT PUMP <br />GAS PIPING <br />PIANC(N�/F� KNUMBER J FEE <br />/ �% �.J / <br />VACANT SITE <br />❑ YES —� ND BUILDING <br />OCLUVANGY NOO�RNflliN60Nrt5 <br />aeao PLUMBING <br />BASEMENT MECHANICAL <br />.—� YES .--; NO <br />HEIGMTLIMITATION ADOITIONALPLANCHECK <br />OTNER <br />STATE BUIIDING SURCHARGE <br />CITY OF EVERETf PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />TOTAL <br />$ <br />0 <br />