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� <br />APPLICATIO►. FOR CONSTQiUCTI"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDI G DEPARTMENT HEATWG SYSTEM: J GAS �J ELECTRIC J __� <br />259 10 <br />DEMOLITION COMBINATIUN FIUILDING MECHANICAL !-! PLUMBING 1 SIGN <br />OWN R MNR A�DRE55 Crtv ZIP PHONE <br />���Q,�o (,�� I�l�'� i9Z� Y9" s�.., r•uar '�•� 3�T -fyi L. <br />IENANT IdARA0DRE5S CITY 21P PMONE <br />ARCHITECTOROESIGNER MFILAODRESS GITY ZiP PHONE <br />GENEPALLONiPALTOF MIILADDRE55 <br />ZIP <br />3TdTE L�CENiE / <br />MECH4NICALCONTRACTOR MAllAODRESS QTY ZIP PNONE STATELICENSE� <br />PLUMOING CONTRACTOR <br />CONTFACI PPILEOF WORN <br />OESLq19E WORH AND SOJRRE FOOTAGE INVOLVED <br />� �� <br />PROPOSED USE OF BWl01NG <br />l[GAL DESCRIP7'ON OF PROPEFiV �SHOW N �ELOW OR FTTACN TWO COPiE51 <br />LOT T BLIX:H G� /�LT— /R 13 / <br />LITY ZIP PHONG <br />PAIiCEL TAX 1 D. NUMBER <br />�gZ�Oj ' Z'O�%9� OW Z_ <br />CONSTRUCTIONLO�NIEN�ER,ADDCESS.TEIEPNONE NUMBER <br />PRq� ECTADDRESS <br />`1lZ/ y„ 4✓f S� G.•Y.G.� cJl^ . <br />NO. <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY�WASH BA@ <br />SHOWER <br />KITCHEN SINK 8 DISP <br />TRAY <br />URINAL <br />DRINKING F <br />FLOOR ORA <br />BACKFLOW <br />ROOF DRAI <br />SINK ISERV <br />OR <br />FOR OFFICE USE ONLY: <br />FRONT SRPACK REAR SBTBALN <br />USEZONE IOTAREA <br />iV^EOfCONSt. NDOFSTORIES <br />S2E Of BIDG FIFE SPRINuEPS REO'D <br />FIRE ALARFI <br />IiE�SON <br />INTAKEBY � PLANSAPPROVEu�� <br />DATE <br />� <br />� <br />� <br />SE1BnGK <br />CONT�CT PERSON AND PHONE NO. <br />1 HEREBV CERTIFY THAT I HAVE READ AND E%hMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. �LL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPL�TED WITH WHETHER SPECIFIED HEREIN OR <br />,,^„ THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />OTHER ST�TE OR LOCAL LAW REGULATING CONSTRUCTIUN OR THE <br />PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV l HE <br />OWNER OF THIS PROPERTV TO PERFORivI THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAVJ RCW AND 296.200 WAC. <br />xGN�iMF OAiL <br />orvauswfss�ro�si uo . _ <br />FeE NO. TYPE OF E�UIPMENT FEE <br />NC—NHNDLG UNITS—H.P. <br />—�— —� FORCED AIR SVSTEMS—B.T.U. M E.A. � <br />, —� —�IT HEATERS—B.T.U. M � <br />VACANT SiTE <br />� � YES � �. NO <br />[`LCU°A'.Lv 4� OICrvI�fRGU4�i5 <br />LiOV� <br />pPSEMENT <br />YES r! NO <br />HEIGHT LIfdITATI�N <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE I <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXH�USTFAN <br />euaoiNc <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PUN CHECN <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORHS <br />T TAL <br />SUBTOT�L 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />FEE RECEIPTNO. <br />VALUATION FEE <br />