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APPLICATIC�1 FOR CONSTRUC7'"�N PERM14 � <br />TO BE COMPLETED IN BLACK INK—PIEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: �AS ❑ ELECTRIC ❑ <br />259-8810 <br />J DEMOLITION C 1 COMBINATION i 1 BUILDING i�AECHANICAL ;; PLUMBING [� SIGN <br />OWNER MAILPODRE55 CITv 21P VHONE <br />r�k Fi 11e�/ �1-01 5�.�..se� �a�.e N�p-¢rs 353- 5%�� <br />TENANT <br />ARCHIiEGT OR DESIGNER <br />GENERALCONTRACTOR <br />AODHE55 <br />MA1L nDDRESS <br />GITV <br />dTV ZIP <br />CITV ZIP PHCNE <br />� <br />MECHRIIICALCONTRAGTOR MRILADDAE55 CI1Y 21P PHONE STATEI 'ENSEt <br />ALP;r•eC.c�r�Q {�.�•bo� ►3;� �oo�, qko�Z y3S•2.�t /-}L�;��c.�4oh5 <br />PLUMBINGCONTRRCT09 MAILAODHESS CITY ZIP PHONE :iTRT[UCENSEP ')/ <br />qy <br />GONTHACT PRICE OF W00K p0 <br />2�0 ,� <br />�ESLRIBE WOFK ANO SOUARE FOOTRGE INVOLVED <br />amioiNc <br />IEGAL OESCRIPTION OF PROPERtt �SHOWN I ELOW OR RTTACH TY.'OCOP�ES� <br />LOT--- BLOCN OF <br />PARCELTA%ID.NUMBER <br />CONSTflUGT10N LOAN <br />KITCHEN SINK & DISP <br />DISHWASHER <br />• LAUNDRYTRAY <br />. CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />NUMBER <br />OR REM <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK I REARSETB�CK <br />iv1'E 0� CON57. <br />52E OF BlW <br />OCCUPANCYIO�D <br />RERSON <br />INTAMEBY <br />FIRE SPRINNLERS REO'D <br />FIRE ALARM REOD <br />PLANSAPPROVELBY <br />DATE <br />�- <br />VACANT SITE <br />❑ VES ❑ NO <br />acuvr,ucr xaa�wnuxeuxus <br />caa= <br />BASEMENT <br />❑ YES C' NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />nNo ra�oNe <br />L71.Z� <br />I HEREBY CERT�FY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TR'lE 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 GRANTI�G 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 CONSTRUCTION OR TIIE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR RS LA 18.2 C� 296200 WAC. <br />�c2 / /� <br />SIGN�LUPE UAE <br />LRY BUSMESS IiCENSE NJ <br />TYPE OF EOUIPM <br />;DLG UNITS—H.P. <br />UNIT HEATERS—B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE I <br />FIREPLACE INSERT <br />FAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />NO. <br />B111L01NG <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BWLDING SURCHARGE <br />PUBLIC WORKS i <br />TOTAL . <br />