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APPLICATIQ`' FOR CONSTRUCT�'�N PERMIT �� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />�._r,n � _ <br />BUILDING DEPARTMENT L <br />259-8810 <br />�DEMOLITION �R OMBINATION <br />HEATING SYSTEM: ] GAS ;b► ELECTRIC ❑ <br />BUILDING ❑ MECHANICAL u PLUMBING SIGN <br />OWNER ' MAiLADDRE55 dTY zIP PNONE <br />��/,c�!%LYi/7<S �i��� EJ1it1/vl.�'7-' �/� L ���('GTT 6y'/� �.�//-�. ��lF' --�f`% '�( <br />TENANT MOtt AODPESS CITY ZIP PHONE <br />AFGHITECTORDESIGNER MARqDDRE55 GITV ZIP PNONE � <br />L�v�'qci� E. �oc�,c'r;rZi 3�i� (oci3y' At��r �`Ur"�c_77-1'✓h', 1��� �.3.�-//!/ <br />MECHANICRLGONTRAf,TOR MRILRDDRE55 <br />PIUMBiNGCONTPACTOR MAIIADDRE55 <br />CQNTRACT"RI�� J <br />�� <br />� `� " <br />OESCP dE WOR ANO SOORPE FOOTAGE INVOLVE[ <br />— �, i y�, '%� <br />PROPOSED USE OF BUILOING <br />��i'./r.� )-/Y/[9VTS <br />IEGAL OESCRIPTION OF PpOPEFTY �SHOWN BELOW OR RTTACH 7 WO COPIES) <br />LOT BLOCK OF <br />PRRLELTA%I.O.NUMBER <br />i��_��04 - <br />LONSiHUCT10N LOAN LENDER. FDORESS. TEIEPH( <br />GTV IIP <br />'fA.%�C;.L� Z' ���C <br />GIiV ZIP <br />���/.�F'�/ � �,i <br />OR ITEM I FEE <br />� PNONE STqTE L�CENSE � <br />f� �, ii1 .. ... . UCi ._ A.>n •� <br />COHTqpT PERSON AND PHONE N0. <br />PHONE STA7E LICENSE � <br />.� =/!� `�✓r' <br />F <br />I HEREBV 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 NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERcIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF AIJY <br />OTHEFi STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />WNTRACTORS LAW 18.27 pCW AND 296200 WAC. <br />' ��� �r . Q //�' //- �� <br />X� !n <br />5� N�LU4E D�iE I <br />Crtv BOS�NE55liL[�bE NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />WATER CLUSET (TOILET) AiC—NHNI <br />BATHTUB FORCED A <br />LAVPTnov nuneu onci.�� ' � - - <br />SHC <br />KITC �! C, � i -- '.... � � <br />DIS! ��' ��� � � ��' <br />LAU <br />CLO / / i <br />URIt _.. /J�� //� , . / . %L% (//�' .. � ,- . <br />DRI� /),/t%'! �/ :7: . (iC ' <br />FLO� � 1 <br />8AC � � � <br />ROC ;�.y �-�� <br />�v�n�rcc a <br />FOR OFFICE USE ONLY: <br />FRONiSETBRCK � REFRSETBACK ` <br />�0 I � <br />❑SE ZONE "'� I LOT AREA <br />� � <br />iYl�EOfCON4. NOAFSTORiES <br />�T- rz 3 <br />512EOFpLDG FlRESPRINKLEBSREOD <br />INTAKE BY PLANS APPI <br />JM <br />oare ��� <br />SIpESETBACK � � PLANCMELNNUMBER FEE <br />L/ f <br />vncnNisrte FFES <br />'�.(FES , NO BUILDING <br />ocr�e�uc+ xo o�owtu�rveuxrts <br />�` I� PIUMBING <br />BAS MENT MECHANICAL <br />VES X NO <br />MEIG�HT/LIMIT TiON ADDITIDNALPLANCHECK <br />rl! 3 ��� C11 OTHER � / <br />�.��/� STATE BUILDING SURCNARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COUE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALPEE $ —T <br />' �(� 'iECE1PTN0. <br />b . /L <br />VALUATION FEE <br />� �1 <br />� LC/��yyJc�� <br />