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APPLICATIC 1 FOR CONSTRUCT~�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATIUN I i BUILDING C"1 MECHANICAL [_l PLUMB.. t.i ❑ SIGN <br />OWNER MRIL^ODRE55 CITY 21P PIIONE <br />� l . Ts 11�-i.. �-i 'i c�% �/Q f/iS <br />GITY <br />PHONE <br />ANCNITECTORDESIGNER MAII�DDPESS CIIY ZIP PNONE <br />GENERAI CONTRACTOR AIAIL �DDRESS C�TV ZIP P��ONE SinTE UCENSE � <br />MECH�NIC�LCONTR�CTOR MAIIRODRE55 GITY ZIP hHONE SUTELIGENSE• <br />PIUMBING CONTR�GTOR MAIL AOORESS CITY 21P PHONE STATE LICENSE • <br />CONTR�GT PRICE OF WORK <br />DESCHIBE NOFlK AND SW �AE FOOIAGE INVOlVEO <br />PROPOSED USE OF BUILOING <br />IEGAL DESGRIPTION tS PROYF <br />ior e�a� <br />PAHGELTAXID.NUMBER <br />7 r� 9n�� <br />CLOSET (TOII <br />IB <br />RYfWASH BA <br />A <br />N SINK 8 DISF <br />1SHER <br />iY TRAY <br />=S WASHER <br />VG FOUNTAIN <br />CONTACT PERSON AND PMONE NO. <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF I.AWS AND ORDINANCES GOVERNING THIS TYPE OF <br />NBELOWORATfACMTWOGOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />— oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�y��� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIGN IS MADF AND I COMPLV WITH THE STATE <br />� CONTRACTORS LAW 1827'1CW AND 296.200 WAC. <br />�oz/— �uo �� <br />TELEPHONENUMBER �/ <br />�_ /_� "/Y "`l : <br />$IGN�IUAE DAtE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACH REPRSETBACK <br />USE <br />TYPE Of Cf1N51. <br />SIZE <br />TOTAL $ <br />MIT $ <br />4L FEE S <br />LOTRFEA <br />NJAF 5T0�'ES <br />FIRE SPRINKLERS fl W'D <br />PdE ALARA' REO'D <br />PI lN5 APPROVEO BY <br />nnre <br />F11J <br />UNIT <br />RANGEHOOD <br />lh'ATER HEATEI <br />WOOD STOVE <br />ME7AL FIREPL� <br />FIREPLACEIN! <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETBACK r�nn wc�� �.�m��� <br />�D; �/ <br />T.U. M <br />VACRNT SIiE rcw <br />C' YES ❑ NO BUILDING <br />OCNPI.bGY HOOipW[IUNGUNiS <br />�9�° PLUMBING <br />BASEMENT MECHANICAL <br />❑ YES r NO <br />N[iGHTl1M�TATIor+ ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL <br />PEFMIT <br />TOTALFEE <br />� i � <br />� �--�J <br />