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APPLICATIf�I FOR CONSTRUC7WN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS �I ELECTRIC '� —� <br />259-8810 <br />! i DEMOLITION x COMBINATION BUILDING � 1 AtECHANICAL PLUMBING i� SIGN <br />'� � � q �/ t 61MLA�OH'G755 � / C.IiY {,Z/�P ^{ FHONE <br />/�lJ?� MRILR�R]� 7 �D� �i�- �'� �[.rlr // P /r/�J PHONE3.3S-�ysy <br />� � <br />pqCMITECTOflOE51GNER MPILAODRESS CITY LP PMONE <br />%� 0 It � <br />GENERPL CONTRACTOF MAIL RDORESS CITY 71P PHONE STAi E LICENSE � <br />� � <br />MELHRNICALCONTRRC70R MAILAD�RE55 LITY ZiP PMONE STRTELIGENSE• <br />�Q h � <br />PLUMBING CONTRACTOR MAIL ADURE55 dTV ZIP ��IDNE STATE LICENSE X <br />�� � � <br />CONTRAC PRICE OF WORR � \ <br />itG .� G ^ <br />OE�GRIBE WORK ANj]FpI RE ^=A� INVOL/V'E l_' C � //� — CON T PERSON FND P 0. „ <br />/ 7 / f�� -L <br />PPJPOSEOJl� E <br />irI'1 I� <br />LOT— <br />PROPERN �SHOWN BELOW OR RTTAGH TWO COPIE51 <br />BLUCM OF <br />?ARGELinaiu.nomecn <br />GONSTqUCTION IOAN LENDER 400RESS, <br />OF <br />iINK 8 <br />1ER <br />TRAV <br />SUB TGTAL <br />PERMIT <br />TOiALFEE <br />FOR OFFICE USE ONLY: <br />FFONTSETBAGN FEARSETBAGH <br />lA/� �c.�4 <br />❑SE2^NE LJTPREA <br />� � <br />7VPE OF CONSi NO. OF STORIES <br />SIZEOF�. FIFESPFINY.LERSREO'D <br />pCLUPANCVLOAD FlREALr1�F.00 <br />r� /Uo <br />onTE ' <br />a ►D - 571.� <br />i HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVE-RNING 1�HIS TVPE 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 ?O '�IOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRi iGTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTH(7RIZED BY THE <br />O'JVNEFi OF THIS PROPER7Y TO PEflFURM THE ��"711K FOR WI iICH <br />APPLICATION IS MADE AND I COMPIV WI1H THE STATE <br />CONTRIjGTORS lAW 18.27 W AND 296200 WAC.• <br />/I <br />— rq.—ninrvv�v��.��. <br />— FORCED AIR SYSTEI <br />UNIT HEATERS—B.T <br />CLOTHES DRYERS <br />VENTILATION FPN <br />RANGEHOOD <br />WATER HEATER <br />� WVUUJIVVC <br />METAL FIREPLACE ( <br />FIFEPLACE INSERT <br />— HEAT PUMP <br />� GAS PIPING <br />, .EXHAUSTFAN <br />`��/o /ati ('Mc t <br />SIDE SETBACN PLAN CHECJ( NU dBE/N� FE[ <br />% (L'J <br />VACANT SITE FEES <br />i�� YES � - N� BUILDING <br />auu=.xr.v xo ��owtioncuxrts <br />no ir � PLUMBING <br />BASEMENT MECHANICAL <br />�' VES .'�� NO �—��-- <br />NEiGHT LnAITnTION ADDITIONAL PLAN CHECK <br />OTH[R <br />S7ATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3705 TOTAL <br />E.A. <br />SUB TOTAL S <br />PERI�-0IT S <br />TOTALFEE S —� <br />/� <br />: a ,/f r .� o� � l�. <br />RECEIPTNO. <br />VALUATIOA FEE <br />�� �2�£� :ScJ <br />b �" <br />J <br />:�[.' ' G(/ <br />i <br />i� <br />C> � <br /></<1,� ! fi� <br />� <br />