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APPLICATIC"11 FOR CONSTRUCT'-1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PR�YT <br />BUILDING DEPARTMENT HEA7ING SYSTEM: U GAS U ELEC fRIC ❑ <br />259-8810 <br />f_l DEMOLITION �-COMBINATION Ci BUILDING I 1 MECHANICAL ❑ PLUMBING C] SIGN <br />OWNEN lAAILA�DRESS �ITY 21P P IONE <br />LAµ/dc;-� s- �f/'nrr�acrL+c,i 2 I, v i7�y� �.�.�n t'cFicF t7- ��i� � i S �-7 yso <br />TENRNT MAILADDPESS GI'V ZIP PNONE <br />ARGHITECTORDESIGNER MRILADDRESS CITY 2iP PMONE <br />GENERnL LONTRAGTOR MAIL nDORE55 dfY 21P PHONE STqTE UCENSE r <br />1✓'41.�'.qcei !-n..� -T !_1 �iL !arl,i r�^^» FLj �S�-'1ySo N�ti3?�il` Z�ooh <br />MECHANICAL WNiRACTOR M41L qD�RESS GITV , ZIP PNONE STpTE LICENSE Y <br />PWMBINGCONTRACTOR MRILRODRE55 ��TY ZIP PHONE STqTELILENFE+ <br />QA :" '' 1V C c" Lv �,J �'1�l O p/%G �s �ES (�C <br />CONTRACT PRICE OF WOR <br />�5 voc� <br />DESCRIBE WORK RND SOUARE fOOTAGE INVOLVE� LONTACT PERSCN AND CHONE NO. <br />1✓F_W Rv'dl� I.S�CJ /JtT.t12 PLUN/1/.✓G �IXIf�±t: <br />F <br />PROPOSED USE OF BUILOING <br />LlGRL DESCNIPTION OF PROPERTv �SHOWN BELOW OR ATTALH TWO LOPIFS� <br />�o.z�.c�� BLOCN�oF s���-r ,�i <br />PARCELTA%ID.NUMBEF � <br />,,�3z-3ti6-oz�-a�ot <br />CONSTRUCTIONLOPNLENDER.RDDRESS.TELEPHONE <br />e,c..r <br />ADDRESS <br />�.� � L .S <br />TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY�WASI <br />SHOWER <br />K�TCHEN SINK 8 <br />DISHWASHER <br />LAl1NDRY TRAY <br />FOR OFFICE USE ONLY: <br />FRONTSETDACK REAq' <br />USE20NE LOTAq <br />irrcorcnxsi. no.oF <br />J�' I� <br />SRE OF pl�G. <br />REO'D <br />WiRKE6V PLANSRPP 9V DOV <br />oaTc fS�ltR/c <br />FEE <br />���nY ���«.s�,. 1 St-�YSo <br />n <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 OFDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THF GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY i0 VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTqUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x ��-� �—/8-i4 <br />S�GNqUPF p��p <br />A/C--ArHNDLG <br />FORCED AIR S <br />UNIT HEATERS <br />CLOTHES DAY <br />VENTILATION ( <br />PANGE HOOD <br />TOTAI S � <br />MIT 3 4 <br />4L FEE � <br />14: O��G7°25 C.�Q�� 2lu U6c. <br />SIDE SETBACK PL�N CN[LH NUM3ER <br />vncarur site FEES <br />G YES i. NO BUILDING <br />OCLO�AHLY NOOipW4LING�M1i15 <br />��J� PLUMBING <br />0 oA5E1dENT MECHANICAL <br />i. ii YES ?/�NO — — <br />NEIGHTUMitAiioN A�DITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SUFCHARGE <br />CITY OF EVERETT PUOLIC WORKS <br />LOCAI SALES <br />� TAX CODE IS 3105 TOTAL <br />M E.A. <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />� <br />