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APPLICATIC'l FOH CONSTRUCT'"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: :.l GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I 1 DEMOLITION ❑ COMBINATION �CBUILDING I MECHANICAL ❑ PLUMBING I_i SIGN <br />OWNER MAILADDRESS CITV ZIP PHONE <br />M�RT/t�f,.11•' ��iRnl�viRT 502/ 3oun���l✓E fvT�E6T/ 9�Zo3 3'{7-6G�f/ <br />TENA� MFIL RODHESS QTV ZIP PHONE <br />MEGH�NICAICONTRRCTOR <br />PLUMBING CONTPRGTOR <br />CONTR�CT PRICE OP W I <br />DESCRIBE WORK AND SOU/ <br />Co✓s%�CNcTi� <br />M�IL ADDRESS <br />in.r . <br />FOOiAGEINVOLVE� <br />cnr <br />/_ ✓E�EG <br />CITY <br />GTY <br />cin <br />PROPOSEDU$EOFBUILDING V <br />G.v �e. q e <br />LEGAL DESCpR.IPTION OF PROPE TY �SNON?! BELOW OR ATTACH TWO COPIES� <br />LOT o BL(`CN 00 " �OF S�'�'&1 �[�(/ <br />P�RCELT�%ID.NUMAEP <br />S i/i- ooy -008'- <br />Cp�STRUCTION LOAN IENDEH, A�ORESS. iELEPW <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DAINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKfLOW PREVENTERS <br />SIN1: <br />NUMBER <br />FOR �FFICE USE ONLY: <br />FRONTSETTRCIS RERRSETBRCN <br />Z� 7 s ' <br />USE2'�0NE��' LOTAREA <br />----�— /�/ 7�'�' <br />1VpE Of CON51I NO OF STORIES <br />SIZEO�BLU�f FIRESPRINNLEFSREO'0 <br />41L. GG LIO <br />INIAKE BV <br />o ere <br />� <br />$ <br />$ <br />$ <br />ur <br />� <br />IIP <br />ZIP <br />21P <br />CONTRCT <br />3 - oS3/ <br />STATE UCENSE � <br />ffiATE UCENSE � <br />STATE LICENSE � <br />3�{7-6H�f/ <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED ?HIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIN(a THIS TVPE OF <br />WORK WILL BE COMPLETEO 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 CONSTFlUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />AFPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />S-i -9 <br />SqN�LME � DAtE <br />dtvBUSMESSl4 �SENO _..__ <br />�E OF EQUIPMENT FEE <br />3 UNITS—H.P. <br />SYSTEMS—B.T.U. M E.A. <br />IS—B.T.U. M <br />CLOTHES DRYEFS <br />VENT'LATION FAN <br />RANCaEH00D <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />FAN <br />SIDESET6RCN PLANGNEGNNUutl <br />7.s' 3� <br />VRCANT SITE FEES <br />� YES '-: NO BUILOING <br />acuv.�r xoaov.Euixeus.�s <br />���v PLUMBING <br />� <br />enSEMEnt � � MECHANICAL <br />❑ VFS �!NO <br />NEIGNTLIMITATION A�DITIONALPLANCHECK <br />� ' <br />O7HER <br />STATE BUI�DING SURCHARGE <br />CITY OF EVERETT rusuc wor' s <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB <br />� <br />