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�` . \ <br />APPLICATI..�N FOR CONSTRUC . IONf PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />L 1 DEMOLITION COMBINATION BUILDING MECHANICAL ' PLUMBING SIGN <br />OWNER MA�L ADDRESS CITv ZIP PHONE <br />;�,/��RoNCfR 3906.P�CKERI¢V• �vE�QF%T WA�$20/ •�o67LS-�i22(i <br />TEN�Ni MAIL DDRESS CITY ZIP PHONE <br />NnwnG <br />ADDNESS <br />ADDRE55 <br />�.M _�fnl .��/ <br />LIY YIIU1Yt <br />ZIP PMONE <br />�,5� 9xoss'Cao� <br />21i PMONE <br />21P P110NE <br />� ��i15TiJCGo 8¢NK' <br />�. <br />ST�TE LICENSE � <br />a�aie u�enoe • <br />SS Q'� WORI.' <br />NEW �I '� ADOITION ��� ALTERATION REP.^` � . DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />� CONT�CTPERSONANDPHO:JENO. <br />ITR�CTPRILEOFWORK I � SO —1�J�O��O <br />�CRIBEw/p RK �ND SOURRE Fi.OTPC INV^p'EC <br />I�nOW �nC . /1/IA.�eI /�Ot��li _ <br />LEG�L OESCRIPTqN pF PRwt <br />�OT BLOCK <br />CLOSET <br />8 <br />FLOOR <br />BACKFI <br />ROOFI <br />SINK (: <br />--�-� �� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />ISHOWN BELOW ORATTACN FOUR COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK N/1LL BE COMPLI:TEU tYITH WHETHER SPECIFIED HEREIN OR <br />. oF NOT. THE GRANTING OF A PEHNIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />— PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STF?E <br />CONTRACTORS W 18. RCW AND 296.200 WAC. <br />x (���� v� 9./ 0• aI L <br />— s��,r�a� ii i s� i � o.,c <br />^ — ---- — — <br />ETC.} <br />ITEM FEE N0. TYPE OF EQUIPMENT <br />A/C—AiHNDLG UNITS—H.P. <br />—r � � FORC�D AIR SVSTEMS—B.T.U. M E.A. <br />—� i I I UNIT F�ATERS—B.T.U. M <br />SUBTOTAL S <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETB4CN PEARSETBALK <br />USEZON[ LOTRREA <br />TYPEOiCONiSALLOWRBL[ i"PEO(LONSI.PLTI <br />SIZEOFBLOG. NOOFSTORIES <br />Mruaeucvinwo F.RESPRNKLEFS <br />HEASON FOR SPRINKlERS <br />PLANS APPROVEO BY <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEhTEI� <br />WOOD STOVE �� <br />METALFIREPLACEV <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETBACN PLnN CNEC� BEP <br />i u% <br />vncnrv� sire FEES <br />BUILDING <br />occuwxcr xoaowewxcw���s <br />cnoua - p�UMBING <br />BASEMENT MECHANICAL <br />HEIGHi UMITATiOrv ADDITIONAL PLAN GHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORHS <br />LOCAL SIILES <br />TAX CODEIS 3105 TOTAL <br />SUBTOTAL <br />PERMIT <br />; S� <br />