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APPLICATIQ�1 FOR CONSTRUCT'�lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM:� GAS J ELECTRIC ❑ I <br />259-8810 ��� ���� <br />I DEMOLITION i COMBINATION 'C BUILDING i J MECHANICAL i 1 PLUMBING I! SIGN <br />OWNER ` MAILA�DRES CIIY I ZIP Pl/ONE <br />�{ Cr�' ���KL\,t� �t w��-�S L P 27? 1 W T a�.ti "k�oo ����� 99zo 1 3S8 -^ti�i,xJ <br />TE�N,AINT h1AILADDRESS _�('� (� 'GITV 21P PIIO�NE p�� <br />l�l� ��" iC.-� �Gr+-r.C� `'�4-" \'t'�'� �� J.—�i�(sC'C\c�..�.�� �i$Q� W�':.'�J�� ' V 4t-'�'�t„ �CXI-�� <br />ARCMITECTORDESIGNER � MNLA��RESS CITv IIP PHONlE1 � \ p <br />+I � f" \— i,� C.��..'�P Z� 3 1 �� { �Ti. .�� "� �L '�U �V Lt�L \` . W� -1 G.-YU \ � W _c.aF'' <br />GENEF�LCONTRACTOR � MAIL��ORESS CIiY � IIP PHJNE STATEUCENSEa <br />s1�t� C'.��,v Po B�� �i,t3.� �r il�•,�-� ��� qf�xs'� �44-`Icxx� sbc.cn��z��Q4 <br />1AECMANICALCONTRACTOR MqILADDRE55 qiY � <br />ZIP PHONE STATELICENSE� <br />MAIL <br />� �V G �m -tr. �- U <br />CONTRACTPRICE WOR <br />� 14-4�� <br />]ESCR16E WGRN �NO SOUARE FOOT/IGE INVOYVFD. <br />CITY ZIP PHONE SiATEL ENSEa <br />�d� ��% Z�l �t.., v � I �'���i uNS <br />� CONTACT PERSON AND PHONE NO �� <br />O,(_ <br />l..W �L` �7 ��lC \� f Il L Y:l1r.`L i ��+�^�1� <br />PROPOSEDUSEOFBUILDING � � <br />C'o :+, rn•-t�, c.. � �t_ <br />LEGAL DESCRIPTION OF PROPERTY �SHOWN 8[LOW OR ATTAGN TiYO COPIES� <br />�or 2 3 S ZL'sLaK ��� oF '�...r.. � W` a... <br />PARCELTA%ID.NUMBER <br />�t' � — (55 0 <br />CONSTPUCTION LOAN LENDER, <br />���� i . <br />PROJECT ADI <br />20C� <br />� <br />TYPE OF FIXTURE OR <br />�YATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN� <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNORYTRAV <br />CLOTHES WASF <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FROYTSETBACK p[�RS[TB4CK <br />USE <br />iIPF Oi WN57. <br />�' �� <br />SI2E OF BLDG <br />2��d i� <br />OCCUPANGYLOAD <br />Ig <br />REnsOrv <br />IN1AKfE 13Y <br />0 <br />SUB TOTAL 5 <br />PERMIT 5 � <br />TOTALFEE 5 . <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 WII.L 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 7HE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORSJ�27 RCW AND 296200 WAC. <br />�_ iGC Y ILYY���� A_� _ �%��,I��� <br />ii - - -`�r <br />smr� mnr oer[ r � � <br />NO. � TYPE OF EOUIPMENT I FEE <br />A�C—A�HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS <br />VENTILATION Fl.N <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREFLACE M'000 BUF <br />FIREPLACE II�SERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIOE SET�aCK I PLAN CNECK NU6SBER_ <br />LOTAREA VACANTSITE FEES <br />.-I YES .-' NO BWLD�NG <br />NO.OPSTORIES O[GU��Cc7 r;�oroWR�wcuAns <br />"�.1. <br />L9�'o PLUM�ING <br />FIRESPRINKLERSREO'0 BASEMENT �,�ECHANICAL <br />,vo - ves y. No <br />=iae n�nqnt n[oo HEiGHr uraiTAnoN ADDITIONAL PLAN CH[CK <br />�L OTHER <br />STATE BWLDING SURCHARGE <br />vinNs nranoveo av CITY OF EVERETT Puouc woaKs <br />�M LOCAL SALES <br />o�,e a��a�ad� TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE 5 <br />� ' J ^ RE�PT� �� <br />L' <br />VALUATION FEE <br />4� �� /� — <br />� <br />� <br />_ i <br />—�— <br />� � <br />