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APPLICATIn ' FOR CONSTR`JCT'`�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: iJ GAS !J ELECTRIC U <br />259-8810 <br />I DEMOLITION f l COMBINATION �BUILDING I I MECHANICAL i 1 pLUMBING I; SIGN <br />O\VNER MAILAO�RE55 GITV ZIP PHONE <br />�lin � T},om,�����1 .5�s� Rock�:c � r Y��(�. �v'���-��_ W A q���? <br />TENANT A1n �DDFESS CITY 71P PMONE ��^ <br />3 � T <br />1..L <br />nv�wrcrrnvnGcir.uco �mn ennaccc CITY 21P PHONE <br />GENERALCONTRACTOR MAILFD�RESS <br />Thar� ���,i���t�q.\�� <br />MECHANICALC TRnCTOR h��OfiE55 <br />PLUMBMG CONTRACTOR MAIL ADDRE55 <br />CONTF�Ci PPICE OP WOPK <br />—'" 4'too `� <br />DESGRIBE \YORK ANG SOUARE F00T4GE INVOLVED <br />PFOPOSE[D]USE OF B/UII�ING <br />TOIt �\ Ci(1� � S�l` <br />LEGAL �ESCRIPTION OF PROPER7Y �SHOWN OEL01 <br />LOT� BLOCN � OF <br />PAFCELi�%ID.NUMBER <br />yq�R- oo�- oo i�- oc <br />CONSTRUCTION LOAN LENDER, pDORESS, TEIEPNONE NUM9ER <br />PROJECTADDRESS 5t�» I�,��x�-F� <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK F� DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEh <br />URINAL <br />DRINKING FOUNTAiN <br />FLOOFl DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEAC <br />SINK ISERVICE-BAR, ETC <br />SUB TOTAI S <br />PERMIT S <br />TOTAL FEE 3 <br />FOR OFFICE USE ONLY: <br />FRONT SE'TBA� , REAR SETBA;K� � <br />Z <br />USE Z LOT AREA <br />�-1 � �r90 <br />TVPE OF LONSi. NO Of STORIES <br />1 <br />SIZE OF BLDG. FIRE SPRINKLERS REO'D <br />� � . <br />OCGl1P�NCV LO�O FIRE ALARM RW 0 <br />PlANS APPROVE[1 BY <br />\� � <br />D�TE ��'j �C.� <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINE� THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PFiOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />VlORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OP CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE 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 S1ATE <br />CONTRACTORS LAW 18.27 RCW AfID 296.200 WAC. <br />TYPE OF <br />AIC—NHNDLG UNI <br />FORCED A!R SYST <br />UNIT HEATERS—B <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPLACE INSEP,� <br />HEAT PUMP _ <br />GAS PIPING <br />EXHAUSTFAN <br />EMS—B.T.U. M E.A. <br />T.U. M <br />SIDE SETBAGK PLnN Cntcn rvuMne� <br />5 �/ <br />VACANT 5�7E FEES <br />,l YES � ��� BUILDING <br />IXCu�>1Cr AC Of pWELLiN40Ni15 � <br />cB"°" pLUMBING <br />M-� <br />BnSEMENT MECHANICAL <br />�—�. YES �. . NO <br />HEIGNTLIMIIATION ADDITIONALPLANCHECK <br />21 1 OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBUC WORKS <br />LOCAL SALES <br />TAX COGE IS 3105 rorn� <br />`iJC I RECEIPT <br />JJ i <br />