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APPLICATIG J FOR CONSTRUCT'�hN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS �ELECTRIC ❑ <br />259•8810 <br />' DEMOLITION �C COMBINATION BUILDING MECHANICAL �! PLUMBING l SIGN <br />OWNER MAILADDRESS CITY LIP PHONE <br />kt.d �� t� _ S w� � t1-F � 1 L t i �"� Pl . l4 l Ic: . Si'�..i t..a � W A. R K Z..�Sf 33�-oK <br />TENRNT <br />MRIL AOORESS <br />CITV ZIP <br />�PCHRECT OR DESIGNEl� MAII AODRE55 CiTV Z�F PHONE - C; �•� � <br />✓�'�.O IfiO�e./C LCLOg� D,T <br />�OENERK MAIL RODRE55 CITY ZIP PHONE STqTE LIGENSE • <br />�'�'i"'-- � 7�.z -/o �� CLu� ,dcr �iC l%c.�...u. I F a�r-i' 335- oE',f'7 <br />MECHANICALLONTRAGiOR MAILADDRE55 CITY ZIP PHONE ST�TELICENSE� <br />PLUMBINGCOM1TR�CiOR MRI�ADDRE55 CITY ZIP PHONE STATEUCENSE• <br />CLASS OF WORK <br />�. I NEW �� ADDITION I-' ALTERATION xREPAIR .� DEMOLITION i-. WOODSTOVE/FRPL7INS�ERT �i i BUILDING RELOCATION <br />u� i_ _ w CONT�CT PERSON AND PNONE NO. ,�J �— /// <br />LOT BLOCK <br />ADDqE55 <br />8 <br />OF <br />OR <br />F�uNPi�it�,U ONc.Y <br />H ATfACH FOUH COPIES) <br />'I -�"L3-OOOL <br />= 9 .Z <br />� SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: ��lninATiuU O <br />FRONT SETBA� / RE�R SETBRCK / SIOE SE� C% <br />USE ZONE_ _ l0T RREA VRCANT SITE <br />TYPEOFCONiS.�ILOWABLE <br />�'iJ <br />SIZE OF BIDG. <br />SPRINKLEPS <br />�I� - <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 L\WS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND:96.200 WAC. <br />A/�AIHNDLG UNIT; <br />FORCED AIR SVSTE! <br />UNIT HEATERS--B.T. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIFEPLACE 8 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN / <br />PIAN <br />BUILDING �� '�`frS� <br />IYFEOFCONS7.AC7UAl tt[urAN[r x0 aow[LLMGuxnS <br />�° 3 f PLUMBING <br />no.� qi�— enSEMENT MECHANICAL <br />FIRESPRNNI.EF59E0'p MEIGHTLIMITATION ADDITIONALPLANCHECK <br />/��J SPRINKL[R <br />STATE BUILDING SURCHARGE <br />PUNSnPPROVEDev CITY OF EVERETT PURLIC WORKS <br />LOCAL SALES <br />i.� ., i_ a_ TAl( CODE IS 3105 rou� <br />�'� <br />`l <br />SUB TOTAL S / ' <br />PERMIT S �� <br />TOTALFEE S � ' � <br />7G.e� <br />( RECEIPT NO. <br />. o yyo3 <br />VALUATI N FEE <br />� a9 ' / S"_ <br />� � <br />� <br />� <br />i <br />� <br />� <br />__"__ _� <br />i <br />.�� <br />i <br />� <br />/i � � C.� <br />