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APPLICATIO`�. FOR CONSTRUCTf�iN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT ( HEATING SYSTEM: � GAS ❑ ELECTRIC J <br />259-8810 <br />DEMOLITION ! COMBINATION BUILDING � i MECHANICAL PLUMBING SIGN <br />pWNIP MAiLApDRE55 CiiV ZIP PHGNE <br />G�5 5t"fu�e 2rxiv ��?4 �1 >r- S:,�i, 9�'29n 33`� l�l7 _ <br />tENANT MAILAO�RE55 CITV ZiP VMONE <br />ARCHITEGTOFDESIGNEF AIAf_qpDRE55 GTY ZIP PMO�iF. <br />MAIL ADDRESS CITY ZIP PMONE STATE LICFNSE R <br />MECHANICFIGONLRALiIfl MAILADDRESS LIiY ZiP VHONt SIMtLIGENSt• <br />PLUMBINGCONTqACTOR MAILADORE55 CIiV ZIP PNGNE STpTELICENSE� <br />CONTRACT P CE OF WORK <br />� 6s; eL ,�I,,� <br />OESGRIBE WOPo: A1lD SOUPRE FOOT�GE INVOlVEO <br />rT �F <br />PROPOSED USF OF BUIL�iNG <br />r <br />LEGAL OESGRIPTIpN OF PROPERI Y ISHOWN BELOW OR FTiACN TWO LOPIE51 <br />,0 13-1'l-�4=�Ga��H �'o -oo Lc �cl Div <br />`�ss /�J �/</`i�o�' �acK <br />PARCEL iA% I D NtIM�ER <br />.5"ooy -on6 - 0�3 -c <br />CONSTFUCTION IORN LENDGF. RDDRE55. <br />2 io• <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATOFiY (lh'ASH BA� <br />SHCWER <br />KlTCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FOUNTAIN <br />ROOF <br />SINK ( <br />OR ITEM <br />F�R OFFICE USE ONLY: <br />FRONTSETBACN� FEARSEiBACN <br />USEZON[ <br />rvv� or corvsr <br />� <br />SRE OF BLDG <br />�J� <br />OCCUPANCYI <br />REASON <br />INiAKE BY <br />FEE <br />J <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 JF <br />WORK l'JILL BE COMPLETED WITH WHETHFR SPECIFIED HEREiN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY l0 VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM nUTHORIZED BY THE <br />OWNER OF THIS PflOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AND 296200 WAC. <br />A/C—AMNDLG UNITS—H.F <br />FORCED AIR SYSTEMS—B <br />UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEfi <br />WOODSTOVE <br />. METALFIREPLACEIWOOD <br />ICI�i\I <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTALFEE $ <br />i1RE SPRINKLERS REO'0 <br />�b <br />FIRE AL4RM REO D <br />PL�NSAPPROVEDBY <br />JM <br />oare ,j �2"� �S� <br />5'DESETBnf.K � PLAN <br />IysVl <br />�v .6"'- 27 -%`/ <br />- oerz — <br />iENT FEE <br />i.U. M =.A. <br />� <br />BURNING) <br />ITAL $ <br />f S <br />FEE $ <br />/1,(Al.� �-i-l�f{vGL <br />F[E �ELEIPTNO. <br />`-l`-/�i.� � <br />VACANT SITE FEES <br />i,�l YES � ��. NO BUILDING <br />aarausv i,ao�nuawnemars <br />°pi° PLUMBING <br />BASEMENi MECHAMCAL <br />] YES , NO <br />HEiGNTUMiinnoN �ODITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT aueuc,voaKs <br />LOCAL SALES <br />TAX CODE IS 3105 Torn� <br />FEE <br />