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APPLICATI� FOR CONSTRUC7�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC f] _� <br />BIIILDING DEPARTMENT <br />259-6810 <br />I DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OVMER �1�IlA�DRESS CIT� ZIP PMONE <br />3 o R �v "r S?o / -725- z 2 <br />TENANT MAIL�DDRE55 CITV 21P PNONE <br />�RCHITECTORD IGNER MAILpDDRE55 CITY ZIP PMONE <br />GENERAICONTRAGT MRIL�DDRESS CITY ZIP PHONE STATELICENSE• <br />9t% � �I% � C^. � /r � • 98osr � 2% ^ � <br />MECHANIC0. CONTR�GTO M�IL ADORESS CITY ZIP PMONE STIITE LICENSE � <br />PLUMBING CONTRACTOF MAIL ADDflESS QTY ZIP P NE STATE LIGENSE I <br />CLASS OF WORK�/ <br />i I NEW /� ADDITION I ALTERATION REPAIR DEMOLITION � WOOD OVE/FRPL INSERT �� BUILDING RELOCATION <br />yp N // ,) C/Q�� TAC/irPEfl50NAND NE O.n /y� ,, /J ��- <br />CONTN�LTPRILEOFN'OPK J7 ID/ O !" "`�_� � G� �`�/�7�NU .�A/C�•/�KF��. 2p . � Lf- <br />DESCRIBE WORK AND SOWNE FW lnut invu�v <br />��coq,r � Qsp �,z <br />PROPOSEDUSEOFBUILDING �U/ L x' • <br />�K/S1µX+ <br />LEG�L DESCHIPiION OF PROPERTY �SHOWN BEIOW Ori A H <br />i <br />LOT��'� B�OLK S OF <br />i _ <br />IPpOJECT <br />� <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRY TfiAY <br />FOR OFFICE <br />USE lp <br />� <br />nv� ov i <br />SIZE OF <br />INTANE <br />DRAIN <br />ONLY: <br />REAR SEl <br />��s <br />LOT RREI <br />� <br />TYPE Of LO <br />� <br />NO. OF 51 <br />NJ <br />+ r. <br />SUB TOTAL <br />PERMIT <br />� <br />PLANSAPPROVEDBV <br />I a ��/�,� <br />SIDE <br />i HERE CERTIFV THAT I HAVE REGD AND E%AMINED THIS <br />APPLI TION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRO IONS OF LAWS ANL ORDINANCIS GOVERNING THIS?YPE OF <br />WO K WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />N . THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />THORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCT�ON. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THF STATE <br />CONTRACTORS LAW 782 RC AND 200 WAC. <br />XNAfURE D�t( �� <br />& <br />GAS <br />B.T.U. M <br />M <br />)TAL S <br />f S <br />FEE $ <br />�� Q 3 %'�CG� � <br />PLANCNECKNUMBER _ FEE RECEIPTNO. <br />��"' BUILDING <br />oceueexa xaamveumeuxns <br />wouv ^ PLUMBING <br />��..` <br />BaSEMENT MECHANICAL <br />✓ <br />HEIGHi LIMITATION ADOITIONAL PLAN CHECN <br />O• SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIG WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTn� <br />� <br />--. A ;3LDD <br />