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- APPLICATIO�` FOR CONSTRUCT[ �N �ERMIT /✓� <br />TO BE COMPLETED IN BIACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT �HEATING SYSTEM: �GAS U ELECTRIC ❑ <br />259-8810 <br />i_ I DEMOLITION ❑ COMBINATION I 1 BUILDING � 1 MECHANICAL ❑ PLUMBING I_7 SIGN <br />OWNER / MAILADDRESS CITY ZIP PNONE <br />a,1 a l� S� l�o.� , �✓�-H�rf SYa o s' 3S3 -�-?� y <br />T NRNi MFIL RO�RESS � CITV ZIP PHONE <br />s�N 1 9 XO��� «Y` LJJ �I <br />ARCHITECT OR DESIGNEA MAII ApORESS �CITY 21P VNpNE <br />GENERALCONTRAGTOR MRILRO�RE55 GITV ZIP PNONE STATELICENSE• <br />�cti(E/«f..:�.,61•� �,n7a.� c.rt�A„<•,,.�/��,t,,.�. � 9�ajG 7�x9�ii sl���N�fo�� <br />MECHqNICRLWNTRAC R MAILADORE55 pTY Z�p pNONE ST�TELICENSEI <br />PWMDING LONiPACTOR MRIL �DDNE55 CITV ZIP PMONE STATE LICENSE � <br />CONTRACT PRICE OF WORK <br />cJ S00 <br />DESC IBEWORKqND50UAREFO0T4GEINVQLVED I � WNTACTPERSONRND?HONENO. D/� ��y_s���r <br />�A�i �Ah ✓QiNSIUti �CA%lv. y _.__ ��' % er �oc <br />PROPOSEO USE OF BUILDING <br />LEGAL DESGRIPTION OF PROPEFTY ISHOWN 6ELOW OR RTTRCM TWOCOPiES) <br />ior e�ocK n� <br />PARCELTAXIU.NUMBER <br />�9Ka -000-oaG -000f <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPMONE NUMBER <br />�i • <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />PLOOR DRAIN <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCK REARSET <br />USEZONE LOT�REA <br />iYPE Of CONST <br />SIZE OF BLDG. <br />OGCUPANCYLOAD <br />FEASON <br />INTqNE Bl' <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FIRE SPRINKLERS REO'D <br />FIRE AL�RM REOD <br />PLAhi APPROVED BV <br />onre <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED 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 ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY 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 1827 RCW AND 296200 WAC. <br />x 1��� �% � A 3—� — Q�-f <br />SqN�iUFF UME <br />FORCED A�R 5' <br />UNIT HEATERS <br />CLOTHES DRYi <br />VENTILATION F <br />RANGEHOOD <br />WATER HEATEI <br />WOOD STOVE <br />METAL FIREPL <br />FIREPLACE IN: <br />HEAT PUMP <br />GAS PIPIPIG <br />El(HAUST FAN <br />510'e SETERCK PUN CHECK NUMBER FEE <br />VACPNT SITE FEES <br />, � YES f�; NO BUILDING <br />OLLUPANCv NO OipNFIUNGONi�S <br />CP°j° PLUMBING <br />BRSEMENT MECHANICAL <br />Cl VES C NO <br />HEiGNTUMITAnON ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SUaCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 �TAL <br />M <br />FEE <br />$ <br />$ <br />a <br />