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APPLICATIC�1 FOR CONSTRUCTr)N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC `J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION I BUILOiNG ❑ MECHANICAL PLUMBING L' SIGN <br />(MAIL ADDRESS CITY ZIP PHONE <br />OWNER — ___ i . . _f. . �­,, _. LL 31913 _ 12" <br />TENANT <br />MAIL <br />ZIP - PHONE <br />CITY <br />ZIP <br />PHONE <br />ARCHITECTOR DESIGNER <br />MAILAD ESS <br />CITY <br />Zip <br />PHONE <br />�1 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />1 <br />-t� . 7d>dL-�y� <br />�u�� J4Sw r <br />t v L3L7J AiD <br />1?1t��46a <br />iZa <br />PHONE <br />STAT�LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />ZIP <br />PHONE <br />STATE LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />1 <br />CONT4T PRICE OF WORK <br />Z1-all lao <br />FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE <br />U4 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING / APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FNDI�arLfL1 fiof L� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY ISNOWNB LOW OR ATTACH TWO COPIES) /✓' WORK <br />THE GRANTOMPLETED WITH ING OF A PERMITJDOES NOT PRHETHER IFIED HEREIN ESUME TO GIVE <br />- 't DLOCKlAr - OF �L S O oT' DM <br />Lo, AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />XGQlrQ _�T V F' �� �,� _ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />L ANS7 cf — PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />` OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />o APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TA%LD NUMBER CONTRACTORS LAW 18.27 RCW ANDS 200 WAC. <br />43�o_-t1a-aZl �omj .. - <br />CONSTRUCTION LOAN IENDER. ADDRESS. TELEPHONE NUTABER <br />S <br />OF <br />CITY <br />II <br />0 <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />;INK 8 DISP RANGE HOOD <br />iER <br />TRAY I WATER HEAIt <br />I WOODSTUVt <br />FOUNTA114 <br />ROOF <br />FAN <br />` O—J'Z -7.3 <br />DATE <br />S <br />SUBTOTAL <br />$ <br />_SUBTOTAL <br />PERMIT $ <br />PERMIT <br />$ <br />TOTAL FEE $ <br />TOTAL FEE <br />$ <br />�U� 647-- dh(/( <br />FOR OFFICE USE ONLY: <br />FEE RECEIPT <br />NO, <br />FRONT SETBACK REAR SETBACK <br />SIDE SETBACK <br />PLAN CHE NUMBER <br />FEES VALUATION <br />FEE <br />USEZONE LOT AREA <br />VASITE <br />YE ❑ NO <br />YE <br />` <br />^I <br />— <br />225 <br />[I <br />❑ <br />BUILDING <br />, <br />TYPE OF CON51. , - NO OF STORIES <br />OCCUPANCY NO or MUTING UNITS— <br />PLUMBING <br />_ <br />Iw <br />SIZE OF BIDG. E SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIREALA MREOD <br />HEIGHT LIMITATION-- <br />OTHER <br />Z/ <br />REASON <br />STATE BUILDING SURCHARGE <br />PLANS APPROVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />1 <br />INTAKE By <br />CjIIP�L <br />LOCAL SALES <br />n% <br />GATE I/1GiG/vl <br />TAX CODE IS 3105 <br />TOTAL <br />