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APPLICATI�''Y FOR CONSTRUCY�N PERMIT � <br />S1Q TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />� I <br />BUILDING DEPARTMENT r HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION L�BUILDING L] MECHAhICAL ❑ PLUMBING ❑ SIGN <br />OYMER M�IL pODRE55 pTV 21P PHONE <br />roSft�u�n�c Lo�sZ. s,e �., ,.a �� E•�y- �i�?os �59--3us� <br />TEN� M�ILADORE55 CITV 2�P VHONE <br />ARLHITECTOROESIGNER M�ILRDDRE55 CITY ZIP PHONE <br />GENEF�LCONTR�CTOR MAILAODRE55 CITY 21P PHONE SiATE1.IGENSE� <br />sf,V�oK��urC�s eaa5 �ur� �L w� mur��TEo 9�a�s aa�-�a.so ��nl�ote_�N <br />MECHNiICILLCONTNRCTOH M�ILADDRE55 GITV ZIP PMONE STATELIGENSE� <br />MUMBING CONTR�CTOR IAAIL �O�flESS CIiY 21P PH�NE STATE UCENSE � <br />CONTR�CT PRICE OF_WORK <br />$pU�RE <br />PROPOSED USE OF BUILUING <br />IEGAL OESGRIPTION OF PROPI <br />l0T BLOCK <br />PARCEL TiVt 1 D. NUM9ER <br />CONSTRUCTION LORN LEI <br />'0 <br />SHOWER <br />TflAY <br />WASHER <br />FOUNTAIN <br />ROOF <br />SINK ( <br />BELOW OH ATUCH TWO LOPIES� <br />- O F — <br />-ctr�o - u3'v <br />5, iEIEPHONE NUMBER <br />FOR OFFlCE USE ONLY: <br />FRONTSETBRCK REARGETBACK <br />USEZONF LOTAREA <br />iYPEOFCONST. ���FSTORIES <br />SIZE OF BLOG. FIRE SPRINKLERS REO'0 <br />OCCUPANCY LOAD FIRE AURM REO'D <br />REASON <br />MT�KEBY PLANSAPPROVE�BY <br />DATE <br />S <br />$ <br />3 <br />CONTRCT PERSON AND PHONE NO <br />i HEREBV 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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOP WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />�I. _ .i�..�(�..,,,.,. .c-cT_�;cc <br />AIR <br />WATER HEATE <br />WOOD STOVE <br />METAI FIREPL <br />FIREPLACE IN: <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />T.U. <br />iiDESETBACK PLANGHECKNUMBER <br />VAGANT SITE FEES <br />i7 YES I. ! NO BUILDING <br />acuvexa xoawrtu�x:uxrts — <br />caour PLUMBING <br />BRSEMENT MECHANICAL <br />C YES I�1 NO <br />HEIGHT uMITnTION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SIILES <br />TAX COUE IS 3705 70T11L <br />M E.A. <br />$ <br />S <br />$ <br />RECEIPTNO. <br />� <br />q <br />