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APPLICI�TIQ�'' FOR CONSTRUCi'1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PIEASE PRINT <br />HEPTWG SYSTEM: �,GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT <br />2;,9-8810 <br />DEMOLITION 1 COMBINATION I 1 BUILDING 1l�iAECHANICAL iJ PLUMBING ❑ SIGN <br />OWNFg� MRIL�ODRESS QTY ZIP PMpNE <br />Jol.� /�� ('ti (�� S7Z� GJ�j� �e �-3_9737 <br />TENAN7 MRII RDD SS GTY ZIP PHpNE <br />GENERRL <br />MECHANICALGONTFPGTOR <br />PIUMBING CONTflALTOfl <br />CONTqRCT PRICE OF WOJRK <br />J <br />DESGRIBE WORK RND SO'JRI <br />/n,s�fi.�� �.rc5�.� <br />iROPOSED USE OF BUILDING <br />LEG�L DESCRIP710N OF PROPf <br />LOT-- BLOCK <br />PARCELTA%IO.NUTABER <br />LONSTRUCTION IO�N LEI <br />ZL <br />MRIL <br />MAII <br />FOOTAGE <br />/ C!•7 <br />CITY <br />�� <br />GITV <br />CITY <br />dTY <br />7i�Go�� �' r pc 3 IS� tY <br />21P <br />� <br />21P <br />ZIP <br />ZIP <br />PMONE <br />Qj�2oy <br />PHONE <br />PMONE <br />PMONE <br />CONiALT PERSON AND PHONE NO. <br />S`5'S� ' . <br />S7ATE LICENSE � <br />STRTE LICENSE � <br />STQE LICENSE R <br />accr�s <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFiECL A�L <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�SHOWNBELOWORRTTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br />°F AUTHORITY TO \'�OLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LUCAL U1W REGULATING CONSTRUCTION OR THE <br />• PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RC AND 296200 WAC. <br />RESS.TELEPHONENUMBER [y\ `-�� <br />� J ' lp-4I' <br />SiGNRUHE D�IE <br />FlXTURE OR ITEM <br />SNOWER <br />KITCHEN SINK 6 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINNING FOUNTAIN <br />SINK <br />TOTAL $ <br />u11T $ <br />�L FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSEiBRGN REARSETBACN <br />USE20NE LOTFREA <br />iYPEOFCON51. NO.OFSTORIES <br />SIZE OF BLDG. FIRE SPRINKLEFS REO'D <br />OCCIIPANCYlOAO FIqEAIARMRE00 <br />MTANEBV PLANSAPPROVEDBY <br />DATE <br />FORCED AIR SYSTEMS <br />UNIT HEATEflS--B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />SIDE SETBACK PLRN CHELK UMBER FEE <br />VACANT SITE FEES <br />❑ VES L I NO g��ILDING <br />OCCJIMNCY NO O�CN[IIINGONI�S <br />�A0°o PLUMBING <br />BASEMENT MECHANICAL <br />�=i YES ��-, NO <br />HEIGHTLIMITATION ADDITIONALPLANCHECK <br />CiHEF <br />STATE BUILDWG SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTIIL <br />S <br />FEE <br />i <br />