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u <br />APPLICATIO'1 FOR CONSTRUCT`�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HFATING SYSTEM• ❑ GAS ❑ EIECTRIC ❑ <br />BUILDING DEPARTMENT ` <br />259•8810 <br />❑ DEMOLITION Ll COMBINATION <br />O E p MRILA�ONESS <br />�l'. � � L � / � ` <br />TENANT MAIL.\DORESS <br />AflCHITEGTORDESIGNEH MAILADDRE55 <br />^ Vf�IXI�I:IVN MI11LpUUM[J] <br />� cun'�i �3� �2 <br />AECHANICRLCONTRACTOH M41l.AD�RESS <br />'UIMBING LONTRAGTOR MRIL RODRESS <br />G/ONTRACT P/R�ICE OF WORK/� <br />K �J V Q - � L1 <br />$CPIBE WORK AND SOURRE FOOiAGE INVOIVED <br />PROPOSED USE OF BUILDING <br />IEGAL DESCRIPTION OF PROPI <br />LOT BLOCK <br />❑ BUILDING ❑ MECHANICAL ❑ PLUMBING Li SIGN <br />C 21P PHONE <br />� �vc.�c_ �r y�a l a� ; .� - � �7 v `7 <br />BELOW OR ARqGH TWOCOPIES) <br />- OF <br />PRRCELTAXIA.NUMBER <br />CONSTPUGTIONLOANLENOER,ADDRESS.TELEPHONENOMBER <br />PiIOJECT ADDRESS �� / /� / I c) / <br />/ lJ d,/ <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEFS <br />f;00F DRAINS—RAINLEAC <br />SINK (SERVICE—BAR. ETC <br />FOR OFFICE USE ONLY: <br />FRONiSETBACK flEAfiSETBRCN <br />USEZONE LOiAREA <br />iYVEOiCONSi. NO.OFSTORIES <br />SIZE OF BLDG. FIRE SPRINKLERS PEO'D <br />OCCUPANCYLORD FIFEAIAPMRW'D <br />pV PLANSAPPFOVE09Y <br />cnTe <br />CITV ZIP <br />CITY ZIP <br />CIIT�Y 21P <br />��� <br />CITY ZIP <br />CITV 2iP <br />PHONE <br />PNONE ST�TELICENSE� <br />'S� —o�i �/ � <br />PMONE STRTE LICENSE � <br />PHONE STATEUCENSE• <br />CONTAGT PEFSON �40 PHONE N0. <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 HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIAT� OR CANCEL THE PROVISIONS OF ANY <br />OTHFR STATE OR LOCAL LAW REGULATING CONSTRUC710N OR THE <br />PERFORMANCE OF CONSTfiUCTION. THAT � AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />� � '�l � t-' 7 <br />TYPE OF EOUIPM <br />N�NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIFiEPLACE (WOOD <br />PLAN CNECN NlIMBER <br />VACANT SITE FEES <br />(.I YES G NO Bl11LDMG <br />OLCUeAHCv N�O�UWFlliN60Hi15 — <br />cnow pLUMBING <br />onSEMENi MECHANICAL <br />G YES i:i NO <br />HEiGHTUMITnTION ADDITIONAL PLAN CHECK <br />OTHEF <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />I�q:l�lll <br />