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APPLICATIQ � FOR CONSTRUCT' lN PE[iMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑�J (�– <br />259-8810 <br />❑ DEMOLITION � COMBINATION p4, BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILA�DRE>S CITY 21P PMONE <br />gTEin�BER6,LAuR�E �IBZ3 5f'i�z:- Cni. �Ue�E17' -�'r8� 03 Zs2-y�28 <br />TENRNT MAILAD�RE55 CITY 21P PHONE <br />FRCMITECTORDESIGNER MAILApOHESS CITY ZIP PMONE <br />E' RALC TR TOR MAILAD E55 CITY ZIP PHONE STATELICENSE• <br />s-' iv,�����;�-+ ��,� �. <br />MECHMlICr1LCON CTOR MAILADOHE CITV ZIP PHONE STATELICENSEI <br />PWMBINGCdJTRACTOP M�ILADDRE55 GIN ZIP PHONE STqTEUCENSE� <br />GONTfl�CT PRICE OF WORN <br />D[SCRIBE WOFK AND $OUARE FOOTAGE INVOLVED <br />�—'�-0�F ZS�Squ�R <br />�S�SE�BU\101NG <br />(� <br />LEGAL OESCRIPTION OF PROPERTV �SNOWN BELOW Ofl ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXID UMOER <br />(vii7 noo b�� <br />CONSTPUCTION LOAN IENDER, ADORESS, TELEI <br />� <br />REM <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCK REAR; <br />USEZONE LOTAF <br />iYPfOFtONSi. NOAF <br />SRE OF BLDG. FlRE SPRINKIERS REOD <br />OCCUPANCY LOR� FlIIE ALAR`A PEOD <br />REASON <br />INTRKE BV PLANS <br />DATE <br />BY <br />CONTACT PEFSON ANO PMONE 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 ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTHUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW�'ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPL �ATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />.�,�,�.�, 2����..�%G� 9 � ��s� <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METALFIREPLACE� <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIOEuETBr1CK PLANCHEG� UM�Eji� FEE <br />T% <br />VACRNT SITE FEES <br />❑ YES ❑ NO BUILDING <br />OCCU�AHb NOOip1'[IUHGOHi13 <br />taour p�UMBING <br />BASEMENT MECHANICAL <br />L! YES n r,o <br />HEIGNT LIMITATION AODITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCALSALES <br />TAX COOEIS 3705 rorn� <br />SUB TO' <br />PERMIT <br />TOTALF <br />FEE <br />a <br />� <br />