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APPLICATIC'� FOR CONSTRUC7'�'JN PERMIT � <br />TO BE COMPLET�D IN BLACK INK—PLEaSE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-6810 <br />I DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING '' SIGN <br />---�-- MAILADDFESS CITV ZIP PNONE <br />i.l �L1iZ� 2zio <br />MA1L ADDRESS <br />��7y ZIP PHONE <br />z iz3z <br />ARCHITEGT OR DESIGNER MAIL ADOFE55 CITY ZIP PMONE <br />GENERALGONTRACTOR MAIL�UDFE55 CITY 21P PHONE STF/T�ELICENSEt <br />r✓'n"r_� %n0/1!_sC T.�f ��% �L1UeL�L�L t�V�%'uZO� ZS`Y17/1 lAEIP61 o�fsJ.� <br />MAIL <br />Z�p PHONE STAiE UGENSE t <br />PLUMBING LONTRACiOfl MRIL RDORESS qTY ZIP PMONE STAiE ItCENSE I <br />I i qDDITION <br />DESGRIBE WORK <br />ALTERATION �� � REPAIR <br />/Z� �JDU.c�o <br />PROPOSED USE OF BUlloirvti <br />C�A� E � STD� F <br />LEGAL DESGHIPTION OF PROPERTY ISNOYM BEL01 <br />LOTZ7 � Z S BLOCK �/7Z — OF <br />�ni c - 47J_ - OZ7 - � <br />PR0.IECTADDRESS � �r D v��a��N�A �i-��E <br />8 <br />FLOOR <br />ROOF <br />SINK 1 <br />FOR OFFICE USE ONLY: <br />FqONT� �K REAR �TBACH <br />� <br />USE20NE LOTAREA <br />,e- Z <br />IYPC .O.rf fLONiS ALlOWPBIE TYCE Of GONSi AGiU/L <br />cno nc ni M NOAF STORIES <br />FlRE SPRNNLERS REO'U <br />uo <br />J� <br />$ <br />S <br />5 <br />C A/ <br />v <br />VNi SITE <br />DEMOLITION WOODSTUVE/FRPL INSERT BUILDING RELOCATION <br />CONTAGT PERSCN ANO PHONE NO. <br />�p OLSoN <br />Ls�t i3J/ <br />OU <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 OF <br />WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br />�r'' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND � COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x /`Y��''� g�ZS�� Z <br />si�v�rone oere <br />nccuo�xcr I xo a w+cuixeuxns <br />L/ <br />CITY OF EVERETT <br />LQ*.pL SALES <br />TAX CODF. IS 3105 <br />TYPE OF EOUIPMENT FEE <br />VDLG UNITS—H.P. <br />AIR SYSTEMS—B.T.U. M E.A. <br />,TERS—B.T.U. M <br />iDRYERS <br />'ION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />TOTAL $ <br />MIT 8 <br />1L FEE $ <br />i 7v � ��� 70 <br />BUILDING 32 � �U ' J <br />PLUIdBWG —7i O(i <br />i <br />MECHANICAL � <br />ADDITIONAL PLAN CHECK <br />i <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />�— <br />PUBLIC WORKS <br />TOTAL � r 9 � o <br />