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APPLICATIC'1 FOR CONSTRUCT"lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: `-� GAS J ELECTRIC J —� <br />BUILDING DEPARTMENT <br />259 8810 <br />DEMOLITION I1 COMBINATION � BUILDING !✓�IECHANICAL i PLUMBING SIGN <br />OWNER MRII RODFE55 CITY ZiP PNONE <br />PK. G1,NE��' �/i�wEr�,� �, g��� �s�-s-�f� <br />TENANT MPILRUORESS CITV IIP PNONE <br />qRLHREGTOADE5IGNER MRILRDDNE55 GtY ZIP PHONE <br />biNER4L LONTFACTOR MRIL AD�FESS CITV ZIP PHONE SiFTE LICENSE � <br />MELHRNiCAL LON7RRCTOR MAIL ADORE55 CITY 21P PMONE STRTE LIGENSE • <br />�e,eG•e.EE.•�.SrS�i�>Q. AG//w��r✓;,vD< �v 9Caoi �s�-3ii� ErE.�GfS/��k9 <br />PLUMBING GONTR4CTOR MAIL nDDRE55 CITY 21P PMONE SiATE IICENSE � <br />WORN <br />J <br />SOU�RE <br />�ia <br />PROPOSEO USE OF BUILDING � <br />l�vs„s�CnGC <br />LEGRL DESCRIPiION OF PROPERTY ISNC WN BELOW OR ATTACN TWO COPIES� <br />LOT BLOCN OF <br />PRRCELTAXID.NUMBER <br />CONSTRULTIUN IOAN LENOER. <br />WATER CLOSET(i0a <br />RATHTUB <br />LAVATORY(WASH BAI <br />SHOWER <br />KITCHEN SINK R DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOF <br />SINK ( <br />NUMBER <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLV: <br />FRONT55TBACK REARSETBRCF <br />USEZONE LOTpqER <br />TVPE Of LON57 NOAF STOPIES <br />SIZE OF BLDG FIRE SPRINI;LERS R[O'0 <br />OCCUPANCVLOR� FIRERLFRMRW'0 <br />REASO'I <br />INiAKEBV PLFNSAP°ROVEDBY <br />CO�A�� R05=N ANO PHONE N0. <br />'-�� <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORAECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMI? DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCC- OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 PCW AND 296.200 WAC. <br />FORCED AIF SYSTEM: <br />UNIT HE4TERS—B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FA� <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METALFIREPLACE(Wi <br />FIREPLACE INSERT <br />SIDESCiBACN P�ANCNECNNUMBER �EE <br />vncnNr srte FEES <br />� �. YES ^. NO BUILDING <br />occuwxcr noorowtwrvcuu�is <br />eanuc PLUMBINu <br />dnSEMGN' MECHANICAL <br />- YES i7 NO <br />HEiGHTUMiTniloN ADDITIONALPLANCHECK <br />pTNER <br />STA1E �UILDING SURCHARGE <br />CITY OF EVERETT PUBLIG WOFKS <br />LOCALSALES <br />o,,,E I TAX COUE IS 3105 TOTRL <br />TOTAL <br />�AIT <br />1L FEE <br />NO <br />0 <br />