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APPLICATIO ^: FOR CONSTRUCTC-1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ EIECTRIC ❑ <br />259-8810 <br />� DEMOLITION �l COMBINATION ❑ BUILDING I_K�iIECHANICAL d?LUMBING ❑ SIGN <br />OWNEH /� MAILADDRE55 CITV 21P HONE . <br />l".�C'I�CX� S�'� ��% S'i�� � �C f C'�(�'� �( ?(' lC" E'� lfJ%i �/'�.� � <br />TEN/JIT MAILAODflESS CITY 2�P—� PMONE <br />ARCHITECTORDESIGNER M�ICADDRE55 CITV ZIP PHONE <br />GENEMLCONTNACTOR MAILADDRE55 CITY ZIP PHONE / STAIELICENSEI <br />��� -J/��{ <br />MECHNlIC/�LCONTFIICTOR M�ILADDRESS CITY ZIP GHONE STA LILENSEt <br />�l�r-►ZC���t% �3�7��1z �t1�1-M.�TR� ir�il E= MCrri�r i�?�r.c� l�- ��cl� - <br />PLUMBINGCON'P�CTOR M�I�ADDPE55 dTV i ZIP PIqNE STATELICE�N7SE� n <br />������ .�'S � � ��� ! j f '/ �l <br />CONTNACT PRICF OF WOiiN �. <br />OESCRIBE WOHk AND SIX1�RE FOOT�GE INVOLVED <br />PROPOSED USE OF BUILDING <br />LEML DESCPIPTION OF PROPE <br />LOT BLOCK <br />PARCELTA%I.D.NUMBER <br />CANSTRUC fION LO�N LENDER, <br />SHOWER <br />KITCHEN SINK 6 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />CONTACT PER: JN ANO PNONE NO. <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />n{� C� APPVOATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />S� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />BELOW OR�77�CM 7WOCOPIE51 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 />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERiY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS lAW 18.27 flCW AND 296200 WAC. <br />ILEPNONE NUMBER 1�v l � . / <br />Y �.Ctl�fntQ��"'����f a IgJq�l <br />I�}!�� �}/��.{.�{/� S�GN/�runE C �- �1� <br />V ' \S 1 ICJI.�� �IlYPU5ME55l�CENSENO. . <br />FJR OFFICE USE ONLY: <br />FPONTSETB�CK REARSETBACN <br />USEZONE IOTAREA <br />iVPEDFCONST. NO.OFSTORIES <br />SIZEOFBIDG. FIRESNNiNnLhHSNEO'U <br />OCGIIPANCY LO�O .•IRE AURM REO'D <br />RE�SON <br />MT�KEBV PUNSAPPROVEUBV <br />ORTE <br />NC-A/HNDLG UNITS-H.P. <br />FOHCED AIR SVSTEMS--B. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYEflS <br />VENTILATION FAN <br />HEAT PU6 <br />GAS PIPI� <br />EXHAUST <br />S:DE SEEiBRGK PLAN CH L! NUMeEfi <br />3sUa <br />VAGRNT SITE FEES <br />❑ YES ❑ NO BUILDING <br />aruwxcv uoaorrtu�xcuwrts <br />LP0°v pLUM81NG <br />BASEMENT MECNANICAL <br />❑ YES n No - <br />HEIGNT LIMITATION AODITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CIiY OF EVERETT PUOLIC WOFKS <br />LOCALSALES <br />TN( CODE IS 3105 TOTAL <br />FEE <br />$ <br />$ <br />$ <br />RECEIPT NO. <br />FEE <br />8 <br />