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APPLICATIC'1 FOR CONSTRUCT'`9N PERNi1T � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: O GAS ❑ ELECTHIC ❑ <br />BUILDING DEPAHTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILAC�Rf55 CITY ZIP PHONE <br />}{,�oc.lJ G�A�r► �rzC� 5�'�ty w��m,��G�w-at,e %Me1i '���oz �ys -ySN I <br />TENM/T M�IlA0DRE5S GTV 21P PHONE <br />MAIL ADDHE55 <br />CITY ZIP <br />�ENER�LCONiR�CiIXi MML�DDRESS GTV ZIP PHONE STRELICENSE� <br />s li(.1= <br />MECMIWIC�� CONTMCTOR MAIIADDRE55 CITV ZIP PHUNE STRELICENSEII <br />PLUMBINGCONTRACiDP MAILADDRESS GTY 21P PNONE STATEIICENSEI <br />CONTAALT PRICE Of VIJi1K <br />� 1'L , yrao /S�'i <br />DESCRIBE WdiK AND SOUARF. FOOT��E INVOLVEU � <br />Nrw �Oq2A6�z 992 � <br />PROPOSED USE OF BUILDIN6 <br />$'7d2%i �oi�. <br />LEOAL DESCflIPTqN OF PROPEHTV �SHONN BELOW OR ATfACN iW0 COPIES) <br />LOT fiLOCK OF <br />yloZ,c� oc� oa�l — <br />PARCEL UX I.D. NUMBEH <br />� CnN5Tl111CT10NLWNLENDER.ADDPE55,TELEPNONFNUMBER <br />�, WATER CLOSET (TOILEn <br />BATHTUB <br />I LAVATORY (WASH BASIN) <br />SHOWEH <br />. KITCHEN SINK 6 DISP <br />� DISHWASHER <br />UIUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIN�RAINLEADERS <br />SINK (SERVICE�AR, ETC.) <br />SUB <br />FOR OFFlCE USE ONLY: <br />FRONTSETBACK HEARSETB�CN <br />� S Si-}owT� <br />USEZONE LOTRREA <br />, _) � U� <br />7VPEOFCONSi. �'10, FSTORIES <br />I <br />52E OF BLD(3. FIRE SPRINKLERS REO'D <br />Z $�f � <br />OCIXIPANCV LOAD FIHE �URM RW'D <br />REASON <br />INTAKEBV PLANSRPPRO�EDBY <br />onre (/1�`�3 <br />� ' <br />GrW T SITE <br />❑ YES ❑ NO <br />r.uouxr xomowEu�xcuxrts <br />BASEMENT �/ <br />❑ YES N NO <br />HEIGIiT LIMITATION <br />�. 1 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONTACT PERSON AND PNONE NO. <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APH�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF U1WS AND ORDINANCES GOVERNING iHIS TYPE CF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEflEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLA7E OR CANCEL THE PROVISIONS OF ANY <br />OTIIER STATE OR LOC�4L LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FQR WHICH <br />APPLICATION I$� MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS L.�/1827 RCW AND 296.200 WAC. <br />FORCED AIR SVS� <br />UNIT HEATERS—E <br />CLOTHES DRYER; <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />INSERT <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHEF <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />ror�� <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />y <br />