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0 <br />APPLICATI''N FOR CONSTRUCT"7N <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: � GAS ❑ ELECTRIC ❑ <br />259-8810 <br />�DEMOLITION i� COMBINATION ❑ BUILDING i� MECHANICAL G PLUMBING SIGN <br />OWNER MAILADDRESS CITY ZIP PHONE <br />�iF �-�H,(;�,-�a-,., 99Zf/ y`'gvcu/ ��e�c�f yr3Zvy �3G-y9f3'— - <br />TENANT MAII ADDRESS LITY 2iP PHONE <br />RRCHI1ECi OP pESIGNEq <br />GENERRICONTRRCTOR <br />MnIL ADDiiESS <br />MRIL AD�PE55 <br />CiiV ZIP PHONE <br />CITV 21P PHONE STATELICENSEI <br />MECHAHICALCONTRACTOF MRILAD�RESS QiV 21F PHONE STATELICCNSEI <br />PLUMBINGCOVTflAGTOR MAILADORESS CITY ZIP PHONE STATEUCENSE� <br />GONiRACT PFICE OF WOqK <br />DESCNIBE NORN IN� SOURRE FOOTAGE INVOLVED <br />PROGOSED USE OF BUILDING <br />LEGRL DESCRIPTIDN OF PROPEFTY �SNOWN BELOW OP AiTALH TWO GOPIES� <br />�or e�aK oF <br />FAqCEI/ %}� Ny.�B(f{ , / — � <br />J G���� �� <br />CONSTRUCTIO� LOAN IfACER. ADDRE55, <br />I� <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET� <br />BATHTUB <br />LAVATORYIWASH BASINI <br />8 <br />II:ISi <br />DRINKING �OUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADEFiS <br />SINK ISERVICE—BAR. ETC.1 <br />��� <br />i S <br />FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSEtBACn REARSEiBACN SiDE5ET9ACN <br />USE20NE <br />ttPE Of GON51. <br />SIZE OF BLDG. <br />OCCUPAHGVLOAp <br />neasor+ <br />MTAKE OY <br />IOTqREA <br />NO. OF STORIES <br />FIRE SPRINKLERS REOD <br />FlRE ALARM REO-D <br />PLANSAPPFOVEDBV <br />DATE <br />FEE <br />VFCANT SITE <br />❑ YES ❑ NO <br />OCLU�ANCY NO W PNfLUNGUYTS <br />GBOJo <br />'J YES ^ NO <br />HEIGNT IIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONTACT PEPSON ANp PHONE N0. <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 IAWS AND ORDINANCES GOVERNING THIS NPE 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 OFi LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE 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 COMPLY WITH THE STATE <br />CONTFACTpRS LAW 18.27 RC � D 296200 W . <br />/ <br />NO. <br />A/C—NHNDLG UNITS—H.P. <br />FORCED AIR SYS7�EM5—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />fIREPLACEINSERT <br />PLAN <br />6UILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHEF <br />SiATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />)TAL $ <br />f $ <br />FEE 5 <br />RECEIPT NO. <br />0 <br />R <br />