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- _. <br />APPLICATIO.J FOR CONSTRUCT. JN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM: i� GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION Ll BUILDING I7 MECHANICAL !� PLUMBING ❑ SIGN <br />OWNER �dniLA�DRESS LITY $iP,f. PMONE <br />EV <br />11C Arc. �t [ne��Ar1[ �F/�/ -rsn4� �i- 98ZL,r � 33 �_oS39f3 <br />TENRNT MAILADDRESS CITV 21P PMONE <br />ARCHITECTORDESIGNER MAILAUDRESS CIiY ZiP PHONE <br />GENER�LCONTRACTOR MAILAODRESS CIN ZIP PHONE STATELICENSE� <br />MECH�VlIG�LCONTR�CTOR,/ MAIL�ODflESS CIN ZiP PNONE iTATE'_ICENSE� <br />�-�7d�Qs flr3;�aJl. /ZnL /'!/ES�/r!: �� Gi/` 9�iZn/ 3s3-33�/�/ �No990C- <br />PWMBINGCONTPpCTOR MAILRDDRESS dT�' IIP PHONE STATELI':ENSER <br />CONTPRCi PRICE OF WORN <br />�f�00U <br />OESCRIBE WOFK RND SOUARE FOOTRGE INVOWED CONTnCT PERSON AND PMONE NO. <br />PHOPOSEOUSE <br />LEGRL DESCRIPTION OF PROPERTY �SHOWN BELOW OR RTTACM TWO COPIES� <br />LOT BLOCN OF <br />PARCELTA%IU.NUMBER <br />y�O73- <br />CONSTRUCTION LORN lEl <br />LAUNDRY TI <br />CLOTHES K <br />URINAL <br />DRINKING F <br />FLOOR DRA <br />BACKFLOW <br />ROOF DRAI' <br />SINK ISERV <br />OR <br />SUB TOTAL <br />PEF;MIT <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAPSEiBRCK <br />USE20NE LOTAREA <br />IVPEOfLON57. NO.OFSTORIES <br />SIZE OF BIDG. FIRE SPFlINNLERS REOD <br />IOPD FIRE PLARAI REOD <br />py I PLRNSAPPROVEDBV <br />I DAIE <br />St0[ <br />i HEREBY 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 TVPE OF <br />WOFiK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM[ 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 BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COA1PlY WITH THE STATE <br />CONTRACT4RS LAW 18.27 RCW AND 296200 WAC. <br />FORCED AIR S' <br />UNIT HEATERS <br />CLOTHES DRYI <br />VENTILATION F <br />RANGEHOOD <br />WATER HEATEI <br />WOODSTOVE <br />METAL FIREPL� <br />FIREPLACEIN; <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />NUM�ER <br />yp� <br />❑ VES —� N� BUILDING <br />acw+vn Nao�ewru�wuxrts <br />4900° PLUMBING <br />BASEMENT MECHAIJICAL <br />� YES NO <br />MEiGHi uMrtATiON ADOITIONAL PLAN CHECK <br />OTHEF <br />STATE BUIL�ING SURCHARGE <br />CITY OF EVERETT PUBLIC WOHNS <br />LOCAL SALES <br />TAX COUE IS 3105 TOTAI <br />U. M <br />� <br />T <br />T <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />RECEiPT NO. <br />G <br />