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APPLICATI( Y FOR CONSTRUCT"ON PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT L- <br />259-8810 <br />11 DEMOLITION <br />HEATING SYSTEM: W GAS ❑ ELECTRIC ❑ <br />I I COMBINATION <br />LI BUILDING <br />K MECHANICAL <br />OWNER <br />MAIL ADDRI SS <br />I I PLUMBING I I <br />SIGN <br />CITY <br />PHONE <br />21PCIA_ <br />TENANT <br />T1 Al y <br />MAILADDRF.SS %7Jf/dT. <br />(� <br />S'6 EVERE7T <br />98.10 �?Sei 7 �? <br />WIT <br />21P PHONE <br />ARCNITECf OD DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONIRACTOO <br />MAIL ADDNESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />MAIL ADDRESS CITY 21P <br />rllO"F STATE LICENSE I <br />/ 97a/—GS/ a .qrF. 4i kYNNLIlOD� 9P03y 7 2 •i_8 fl r 7'nr o i c-S <br />zlr <br />MAIL nnonESR cNr <br />PRONE STATE LICENSE I <br />CONTRACT PRICE OF WORK <br />3OUAn o0 <br />DESCRIBE WORK AND SOUnRE FCOIAGE INVOLVED <br />rROPOSED USE OF BUILDING <br />LOT (DOCK <br />PARCEL TAX I.D. NUMBER <br />,;F/a <br />CONSTRUCIION LOAN LEF <br />BE[ DIN OR ATTACH TWO <br />- DF <br />-a -cz�i - <br />PLUMBING <br />NO. TYPE OF FIXTURI <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />13ACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEAC <br />SINK (SERVICE -RAM FTr <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK BEAR SETRACK <br />TYPE OF CONST. NO.OF STORIES <br />SIZE OFBLOG. FIRESPBINKLERSREO'D <br />OCCUPANCY LOAD FIREALARMREOD <br />REASON <br />INTAKE BY PLANS APPROVED RV <br />CONTACT PERSON ANO P410NE NO. <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 TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCA.' I-AW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONS TRUCTION. 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNA NRE O %/r/ DATE <br />CDv DI1Sn1E5Ti l%ENSE NJ. - <br />METAL FIRE <br />FIREPLACE <br />HEAT PUMP <br />SIDE SE 113ACK <br />_VACANTSITE <br />rl YES I I No <br />ffN;mnrn <br />BASEMENT <br />11 YES I I NO <br />ECIIANICAL <br />NEIGIII LTMIIATKNI <br />ADDITIONAL PLAN CHECK <br />OTI IER <br />STATE BUILDING SURCITARGE <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />OF <br />rFF <br />-B.T.U. <br />M <br />TOTAL FEE $ <br />DATE I TAX CODE IS 3105 1 TOTAL I <br />