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APPLICATIO''` FOR CONSTRUCT� �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS I�j ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOUTION f� COMBINATION �ki BUILDIWG ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MFiLpODRESS CIT1' ZIP PHONE <br />� ,N <br />r' J�or So✓Z4 `/�= /=,.cr d''�o3 — ZJ,S � <br />TENRNT 1dAIL ADDRESS CITV ZIP ~ PMONE <br />DESIGNER <br />CIiV ZIP PNONE <br />GENERALCONTFAGTOR MFILpODRE55 GTV ZIP PNONE SIATELILENSEt <br />MECMANICALCONTRRCTOR MAILAO�RE55 CIiY ZIP PNONE STATE4CENSE• <br />PI.UMBINGWNTRACTOR MAILAODRESS CITV ZIP PHONE SiATEUCENSE• <br />LONTPALT PRIC� OF WORK <br />z b'.s 0'O — <br />�ESCRIBE WORK AN� SOUARE FOOTAGE INVOLVED <br />PROPOSED U$E OF BUIL�ING� � D UPK+7� � <br />SF1� <br />LEGRL D/ESpCRIPTION Of PNOPERTV ISN0IYN BELOW OR ATTACM TWO COP�ES� <br />LOT—� BLOGK /� OF <br />�� r► a.� �+- �! �� 9 C�3cf� .� <br />�/ ii,.Jn `7/ /Ou-1-Q // <br />PRRGELTAXI.D.NUMBEN <br />��vi -U/G�^o/a-CG <br />CONSTRUCTIONIOPNLEN�ER.FDDRE55,7ELEPMONENi <br />PROJECT ADDRESS <br />3/03 �o�%iG �iJ <br />PLUMBING <br />NO. TYPE OF FIkTURE OR ITEN <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEAS <br />ROOF URAINS—FiAINLEADERS <br />auK isFRVICE—�AR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONTSETBAG � l REp�° <br />7YPC� �Sr � <br />52E OF LDG. <br />�(0�-�1�._ <br />OGCl1PANGV LOA� <br />—�i�-- <br />RFASON <br />INTAKE BY <br />TOTAL 5 <br />dlT S <br />1L FEE 3 <br />l 5!DE SETBACN , / <br />LO7 AREA VAGANT SITE <br />YES NO <br />NO-OFSTORIES acuo�xcr xao�ox'Ru�.coxrt6 <br />� <br />h`°:�z �1 <br />FIRE SPRMKLERS REO�U <br />A(D <br />DATG <br />av <br />qcmcni <br />�:1 YES �0 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COUE IS 3105 <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANG CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPi ETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIATE OFi CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br />�� 1%. ���� ��i ��9s� <br />SIGNAiUi1E O�iE —� <br />:ED AIR SYSTI <br />HEATERS—B: <br />'HES DRYERS <br />'ILATION FAN <br />WATER HEATE <br />WOOD STOVE <br />METAL FIREPL <br />FIREPLACE IN'� <br />HEAT PUMP <br />GAS �IPING <br />EXHAUSTFAN <br />BUILDING _ <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />SiATE BUILDING SURCHARGE <br />Pueuc woars <br />TOTAL <br />M <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE S <br />��� /� REGEIPTN� <br />p_,,3 3 <br />VALUATION FEE � <br />Z ' .0 <br />���L�� <br />i <br />9�i�� <br />