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APPLICATIQ- : FqR CONSTRUCT'�1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC L.l _ <br />259-8810 � <br />; DEMOLITION t I COMBINATION I 1 BUILDING �e�MECHANICAL ❑ PLUMBING SIGN <br />01YNEF MAILADORE55 GITV 21P PHONE <br />�1u.�, 'K�S�S �t�� �,.�c=�� v���,J�2 (�T�^T `t�2�3 <br />TENANi NAILRDDilE55 � G�TV 21P PHONE <br />AqCHRECTORDE5IGNER Id4:LRDDRE55 GIiV LP PHOnE <br />GENERnLCOYIRnCTOR IdA�LAD�PE55 GITY 2iP PHONE STRTELICENSEa <br />MEGN4yICAL�;ONTIj�OR. /�MA���� ������� CIT� �� ��� _ �{'� �� STATE�iC��������� <br />!/11I V V Vv 1 � C�) �V <br />PL MBINGCONTRr1CTOR MRILApORESS CITY ZiP PHONE STAIEUCENSEY <br />CONTRAGT PRIC[ OF W� �— �-�] <br />"� Z <br />�ESGRIBE WORN ANO SOOARE FOOTAGE INVOLVEO <br />us <br />PROPOS[0 USE OF BUILDING <br />LEGAL DESCFIPTION OF PROPERtt �SHOWN BELOW Oq ATT�CN TWO COPIES� <br />LOT BLOGH OF <br />PARCELTR%I.D.NUMBER <br />CONSTNUCTION LOAN LENDEH. ADDF[55. TELEPHONE NUMBER <br />PROJECTADDRESS / �v <br />icn,,� �,()007��1,�F�..% � <br />OF FIXTURE OR ITEM <br />LAVATORY (WASH 6ASIN) <br />SHOWER <br />KITGHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY?RHY <br />GLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE(iS <br />ROOF DFAINS—RAINLEAD <br />SINK (SERVICE—BAR, ETC <br />� TOTAL <br />FOR OFFICE 4'SE ONLY: <br />FHONTSEI�/Ck REARSETBACN <br />USEZOM1E LOTARER <br />tVi'E Of CONSi NOAF STORIES <br />SiZE OF BLDG FIFE SPRiNNLERS REO'D <br />OCGUPFNCY LOAO FINE A�ARM REO'D <br />P.il.KEBY PLlNSaPPROVED <br />on�e <br />CONi4CT PERSON AFD PHONE NO. <br />9�,�2c�{cn_A� �22� � q_I___ <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 WHETHER SPECIFIED HEFiEIN OR <br />NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL lAW REGULATI�CO�JSTRUCTION OR THE <br />PERFORMANC OF ONSTRUCTION. AT I�HORIZED BY THE <br />OWNER 0 HI R P P FORM E ORK FOR WHICH <br />APPLIC 10 ADE I CO ITH THE STATE <br />CONTRA A 18.27 R AND 29 . 0 <br />FEE NO. 7YPE OF EQUIPMENT <br />A/C—NHNDLG UNI7S—H.P. <br />� FORC[D NR SYSTEMS—B.T.U. M @.A. <br />UNIi�HEAT[RS---B.TU. M <br />CLOTHES URYERS <br />�lENTILATION FAN <br />—� _ — <br />RANGEHOOD <br />N.'ATEF HEAiER <br />\NOOD STOVE <br />IAETAL FIREPLACE IWOOD BURNING) <br />� FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />S <br />5 <br />5 <br />SIpE SETBACI; � �LAN <br />f�� YES i.-. NO pUILDING <br />occuv.ucr xno�o-.vEuni,ux.�s - <br />cccuo PLUMBING <br />�ASEMEHT MECHANICAL <br />; YES : , NO <br />HEIGHi uMnnnON ADDITIONAL PLAN CNECK <br />OTHER <br />STATE BUILDING SURCHAFGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 TOTAL <br />0 <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE $ <br />FEE RECEIPTNO. <br />VALUATION __ FE T <br />T <br />