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APPLICA'�IC�1 FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />f l DEMOLITION �COMBINA110N L I BUILDING I' MECHANICAL 1 PIUMBING C1 SIGN <br />ONTJER MRI�qpORE55 CITY ZIP PHONE <br />��.�� C..., ,'1-L� 11'e \ Z '��� P L S L l.lc S-i't rt cS w ih 9 83�S�i 3 3S- o�� <br />TENANI MAILADGFESS GITV Z�P PNONE <br />N UY3 L. _ <br />ARCHITECiORDE5IGNEP MAILADDRE55 dTV ZIP PHONE <br />GENERALCONTRAfTOq MFIL <br />S�_ <br />MECNANICAILO:..:��CTOR MAIL <br />�4_� <br />PLUMBINOCONTRRCTOR MAIL <br />GONTRACT PRICE OF WORK <br />RNDSOUAREFOOTRGE <br />PROPOSEO USE OF <br />LEGAL DkSCRIPTION OF PROPERTY �SHOWN BELOW OR ATiACH TWO COPIES� <br />� LOT BLOCK OF <br />PARCELiA.`. D NUTAOER <br />, -50' - 0�3 - <br />CONSTRUCTION LO�N LENDER. �D�HE55 <br />IS Olf�. <br />PROJECT ADDRESS <br />ZZZo S-k,...�,..-. ,T <br />PLUMBING <br />NO. TYPE OF FIXTU <br />� WATER CLOSET �TOILE <br />BATHTUB <br />LAVATORY�WASH BAS <br />SHOWER <br />KITCHEN SINK 8 DISP <br />TRAY <br />WASHER <br />FOUNTAIN <br />ITEM <br />SUBTOTAL $ <br />PERMIT S <br />TOTAI. FEE S <br />FOR OFFICE USE ONLY: <br />FR�'+TSEiBACK RERRSET6ACK <br />❑SE ZONE �O j l0T AREA � <br />� � D� <br />ttPEO(LONSi. NO.OFSTORIES <br />SIZE OF BLOG. FIRE SPRINKLERS REOD <br />��� ..�� �VO <br />OCCUPRNCY LOAD FlRE ALARM REO'0 <br />FEASON <br />INTRKE 9V PLANS AP�R�VEO Bv <br />OATE / /2n � <br />dTV <br />GRY <br />LITY <br />ZIP PMONE <br />ZIP PHONE <br />ZIP PHONE <br />(4-.� a 5,.,,� T <br />CONiACT PERSON AND PHONE NO. <br />z-t �_�t � 9'7 <br />SUTE UCENSE M <br />IICENSE / <br />LICENSE � <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />Al.'THORITV 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 AUTHOFIZED BY 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 18.27 RCW AND 296200 WAC. <br />A/C-A/HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B: <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DFYERS <br />VENTIIATIUN FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACEINSERT <br />SIOESETBALK PLFNCNEGR metn <br />VACRNT SI7E EE� � <br />i �' YES ❑ NO BUILDING <br />0:4U�ANLY NOqMIfLLIHG111115 <br />�Bp°3 1 PLUMB�NG <br />BASEMENT MCCHANICAL <br />- ves �o <br />HEIGNTLIMITniION ADDITIONALPLANCH[CK <br />�/ .� 1 <br />C�CJ OTHER <br />STATE 6UILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />F�X CODE IS 3105 TOTAL <br />M <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />do/. �� <br />EE PE <br />/� • ��u <br />FEE <br />� <br />Id/ i �,-� <br />���iC� <br />