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APPLICATIC <br />i FOR CONSTRUCT )N <br />PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ _ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />'-1 BUILDING I -I MECHANICAL <br />C', PLUMBING :. SIGN <br />MAt ABONE55 <br />c/WFEV/L �/ONN$%�Yt+ 3N�y <br />-CITY 21P PNGNE <br />/2L��rPfe((�/ eyc-,�tE c7 Y�'�o� <br />KS� C2 <br />E <br />TENANT MAKE ADLNIL 5 <br />CRY ZIP PHCM1E <br />MLNITCCi OR OESIGNEP WKE MPPE58 <br />CRY ZIP PHONE <br />GENERAL CONTRACTOR WKE ADCPE55 <br />CTIY ZIP PHONE <br />STATE LICENSE <br />oWYYec' <br />MECHAICALCCNTRALTOR WE ADDRESS <br />CRY ZIP PHONE <br />STAIEL"11SEA <br />PLUNIBNGCCNTRACTCLR MAILADDRESS <br />OTY ZIP PHONE <br />STATELC NSEA <br />CONTRACT PRICE OF YNDPK <br />DESCRIBE PORK AND BOUARE FOOTAGE M NDLVED O Sd r3 \ <br />CONTACT PERSON AND PHONE 1q <br />lzc- (4»F GwV� a z <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 />CONTRACTORS LAW 18.27 ROW AND 296.200 WAG. <br />X ILL 437IOIIIA. C13 <br />PRGPOSEDUSE BU1,DXa <br />\o( S F= <br />LEGAL. DESCRIPILN OF PROPERTY I5NAN BELOW OP ATTACH TWO COPIES! <br />LOT BLOCK CA <br />3 e,4z� ��`r¢, fe ��2 �VO,yEQ� <br />-- <br />PARCEL TAXI D NUMBER <br />CWSTRUCTYJNLCAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />9iry° a wrt <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 />i <br />A'C-AHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY(WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK S DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BALKFLOIV PREVENTERS <br />GAS PIPING <br />—� <br />ROOF GRAINS-RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE -BAR. ETC.) <br />SUB TOTAL $ <br />SUB TOTAL S <br />_ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTALFEE S <br />nn OFFICE USE ONLY <br />FRONT SETBACK <br />REM SETBACK <br />BIDE SETBACK <br />PLWCHECKNUMDER <br />FEE <br />PECEiPTNO. <br />USE ZONE <br />LOT AREA <br />VAONM50E <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />rvP[afIWBT. <br />NO OF STORIES <br />(p4PAI4r aP4wMAX`.A <br />PPa <br />PLUMBING <br />SIZE tK BIOG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />CtCUPANCY EGAD <br />FIRE AUPN PEOD <br />NEIGITT WRAiKRN <br />OTHER <br />PE0.5ON <br />STATE BUILDING SURCHARGE <br />A < D <br />MAKE BY <br />PUNBAPPROVEDBY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />19 5 <br />