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APPLICATIC.4 FOR CONSTRUCT .JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT �w <br />HEATING SYSTEM: %U GAS <br />U ELEC I HK: <br />u <br />I <br />BUILDING DEPARTMENT—� <br />259.8810 <br />COMBINATION <br />BUILDING <br />MECHANICAL PLUMBING SIGN <br />DEMOLITION <br />ZIP <br />PHONE <br />OWNER ''// <br />MAIL ADDRESS <br />q -T `f�` �.� <br />CITY <br />•r <br />q(�ZJL Z5Z-WL01 <br />E' W <br />LI1�11G ! l , k <br />:5 0 1 \41�'rY�O <br />- <br />PHONE <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />LITY <br />ZIP <br />PHONE <br />STATE LICENSE t <br />MECHANICAL CONTRACTOR <br />MAIL AD.D.RFFSS <br />PiJ*Ao <br />.4 <br />�y <br />L <br />pO{'S^ACJ <br />ST/LI1��`I�f <br />.... ..e.,� �.,uroAnrna <br />MAIL ADDRESS <br />CPn'Y�V <br />CLASS OF WORK <br />REPAIR <br />DEMOLITION INSERT BUILDING RELOCATION <br />WOOAND <br />NEW 'ADDITION <br />ACT PERSON oNEOoEIFRPL <br />2 �/f 1A�LTERATION <br />— <br />3 <br />CONTRACT PRICE OF WORK `"�,J- <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />11 ^ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PPOPEPTV!SHONTI BELOW OR ATTACH FOUR COPICSI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />NOT. THE <br />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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />-- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAG. <br />7/93 <br />-- <br />PROJECT ADDRESS <br />A, <br />S gNIIURE <br />AIR <br />T.U. M <br />SINK. 8 <br />HER <br />'TRAY <br />FAN <br />URINAL FIREPLACE IN; <br />DRINKING FOUNTAIN I HEAT PUMP <br />FLOOR DRAIN GAS PIPING <br />BACKFLOW PREVENTERS EXHAUSTFAN <br />ROOF DRAINS—RAINLEADERS <br />SUBTOTAL $ <br />SUB TOTAL <br />$ <br />PERMIT $ <br />—ram— <br />PERMIT <br />81 <br />Ts FFF $ <br />—� <br />7o1AL rce <br />I <br />$: <br />I <br />FOR OFFICE USE ONLY: <br />FEE <br />R <br />PEAR SETBACK <br />SIDE SETBACK <br />LAN CHECK NUMBER <br />FRONT SETBACK <br />FEES <br />VALUATION <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />BUILDING <br />TYPE OF COATS. ALLOWABLE <br />TYPE Of COAST. ACTUAL <br />06CIIWOLY <br />NG IPAFIUNGAMTS <br />PLUMBING <br />SIZE OF BLDG, <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS REO'D <br />HEIGHT LIMITATION <br />SPRINKLER <br />REASON FOP <br />STATE BUILDING SURCHARGE <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />INTAKE BY <br />LOCAL SALES <br />_ <br />TAX CODE IS 3105 <br />TOTAL <br />N <br />a <br />