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u <br />APPLICATIO,'� FOR CONSTRUCTI�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: 'J GAS J ELECTRIC J <br />259-8810 � �` <br />DEMOLITION ! 1 COMBINATION BUILDING /MECHANICAL /F+LUMBING SIGN <br />OWNER l.INLApORE55 CITV 21P PHON[ <br />_DorfA�/7 S�ir�iTi� 5G/t' ,�'oar✓v Au F�/eF�f�9.�'o?v3 <br />tENANT 61AIL ��DR[55 � CIIY 2iP PHON[ <br />ORD[SIGNEP M1IAiL <br />]NiR�CTOP I.IAIL <br />iq1�C"-�� <br />LCONTRACiOR ldAR <br />�gL��/�� <br />:OVTRACTOR MAIL <br />9% T� � <br />PRICEOFWORNP/ /w <br />PROPOS[C USE OF BUILOING <br />LEGAL DESCBIPTION OF PROPERiY �SMOWN BELON OR FTTACH RYO COPIES� <br />lOT BLOCK OF <br />Pr1RCERA%I D. NUMBER <br />CONSTRUCTION <br />NO. TVPE OF FIXTI <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH 8A: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />:LOTHES WASHER <br />SUB TOTAL $ <br />PEFiM1T 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCN REFRSETBACN SIOESETBAGK <br />❑SEION[ <br />7YVEOf Wfl51 <br />SIZE OF Bt�G <br />cH:GUPANCVLOAD <br />RF�SnN <br />i4tA✓f Rv ���� � "- ��� <br />LOTAREA <br />NO OF STORIES <br />FIRE SPRINKlER5RE0'D <br />°IRE �L�RiA H[O'U <br />�9n1l.`inVi'110VLbOv � �� <br />�,�<< <br />CIiY <br />PHONE <br />PHONE <br />%%�Lo/�/o ��'Z <br />LiCENSE � <br />%/rd/��7/1Z <br />I HEREBV CERTIFY THAT I nAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORflECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOPK 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 T OVISIONS OF ANY <br />OTHER STATE OR LOCAL �.A UL G CO ST N OR THE <br />PERFOR CO UCTIO HAT I A A H 2ED BY THE <br />OWN OF P PERTY TO RFORM W K FOR WHICH <br />APP CAT IS MADE A I COM H THE STATE <br />CON AW 1827 q ND W <br />FEE NO. TYPE OF EOUIPMENT <br />� A�C—AiHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE �WOOD BURI <br />FIREPLACE INSERT <br />� <br />HEAT PUMP <br />GAS PIPING � <br />� EXHAUSTFAN <br />PLr1N <br />VACFNT SITE FEES <br />.. VES -. NO BUILDWG <br />eccvnA��cv xoarowtmr����.,is <br />caouv PLUMBING <br />onSEMENi MECNANICAL <br />� � YES `�,� NO <br />nGiG11T uMlinnoN ADDITIONAI. PLAN CHECK <br />orne� <br />S1AlE IlU1L01NG SURCIIARG@ <br />CITY OF EVERETT rum ic woi�Ks <br />LOCAL SALES <br />TAX COUE IS 3105 rorn� <br />E.A. <br />)TAL $ <br />i S <br />FEE S <br />RECEIPT NO. <br />FEE <br />A <br />A <br />