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APPLICATIC"1 FOR CONSTRUCT`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: O GAS ] ELECTRIC ❑_ —1 <br />BUILDING DEPARTMENT - <br />259-8810 <br />�" DEMOLITION i� COMBINATION I 1 BUILDING 1 MECMANICAL i=! PLUMBING SIGN <br />OWNEF M/'LADDFESS CITV 21P 4'F�,� PHONE <br />i.//1�� jPrir/[.P l- Q+ �O�i L�i /i�r: �•n � �%�-/�d['� <br />iENANT MAIL AD RE55 CITV Z�P rn�rve <br />ARCHITECT OA DESIGNER MRIL ADORESS CITV ZIP PHONE <br />GEYERAL ONTRRCTOR MRIL ADDRE55 QTV LIP PHONE SiRTE UCENSE � <br />. - � �U -✓ � <br />MGG11M11MlGONTq�CTOR AILFDDRESS CIiV / 21P PMONE STATELICENSE+ <br />Syd Eir�t�st+J � l�c' �� w��y !y isr'/�� <br />........,�.�.....�.� e.�.n u�n ennocsc CITV � ZIp PNONE STATE LICENSE � <br />C01lTpACT PRILE OF WORK <br />DESCRIBE WORK AND SOURRE FOOTAGE INVOIVED <br />PFOPOSED USE <br />LEGAL DESC IP7I N OF PROPERTY �SHOWN BEL01 <br />LOT� PLOGK � OF <br />y �•ri - s.�, <br />CON51 RUG�ION IOAN LENOEH. <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA'� <br />SHOWER <br />KITCHEN SINK 8 DISF <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHEP <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />POOF DRAINS—RAI� <br />SINK (SERVICE—BAF <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFlCE USE ONLY: <br />FRONTSETBACK REABSETBACK <br />USEZONE LOTAREA <br />TYPEOLCONST. NO.OFSTORIES <br />S12E OF BLDG. FlRE SPRINHLEFS PEO'D <br />OCCUPANCYLOhD FlREAURMRE00 <br />INTANE BV <br />DATE <br />AND PMONE N0. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />TWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />��'� NOT. THE GRANT!NG OF A PERMIT DOES NOT PRESUME TO GIVE <br />/))��AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�, OTHER STATE OR IOCAL LAW FiEGULATING CONSTRUCTION OR THE <br />- PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTOFS LAy/1827 RCW AND 296200 WAC. <br />AIR <br />FAN <br />WATER HEATE <br />WOOD STOVE <br />METAL F�REPL <br />FIREPLACE IN: <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESETBACK PLANCHECKNUl.IB[R FEE <br />V�LANT SITE FEES <br />❑ YES !—' N� BUILDING <br />acuo.xcv xoav+rcwxcuuns '— <br />caouv pWMBING <br />BnSEMENT MECHANICAL <br />C YES � NO <br />HEIGNi �IMITATION A�OITIONPL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CIiY OF EVERETT VUBLIC WORNS <br />LOCALSALES <br />TAX CODEIS 3105 TOTAL <br />M E.A. <br />TOTAL $ <br />UIT $ <br />1L FEE 8 ' <br />� <br />