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APPLICATIC`�I FOR CONSTRUCT"� 1N PERMIT 435�� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING D�PARTMENT L <br />259-8810 <br />! I DEMOUTION f� COMBINATION <br />OWNEq MFILADDRESS <br />�N�i✓�.r�.✓ / / �.�7/ � d <br />iENAN7 MNLADURE;S <br />AflCHITECTOFDESIGNER MqILA00RES5 <br />GEIiERALCONTR4CTOR MAILA�OqESS <br />PLUMBING <br />-r-� <br />MAIL qDDRESS <br />C�RACT PRIGE OF WORN <br />� �� � <br />L'cSCRIEE WORN AND SOU41iE FOOiAGE INVOLVED <br />HEATING SYSTEM: � GAS a ELECTRIC ❑ � <br />C l BUILDING f✓MECHANICAL ❑ PLUMBING f-� SIGN <br />��T� ZIP ounuv <br />PROPOSE� USE OF BUILDING <br />LEGAL DESCFIPiION OF PROPERTV �SHOWN BEIA W pq pRpCH TWO COPIES� <br />LOT flLOCK pF <br />PFRCEL1q�ir,NOMBER <br />�O/�—OOn — Qs <br />CONSTRUC710NLOANLEY�ER.ADORESS.TE <br />FROJECTADDRESS <br />n�• TYFF.OF FU(TURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 71SP <br />� DISHWASH[R <br />LAUNDRY TRA'! <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—RAR Frn � <br />=C.L[� <br />NE NUI.I�ER <br />PERMIT <br />TOTAL E <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSET�ACK <br />USEZONE LOTMEA <br />iYPEUfCONSi NO.OFSTORIES <br />SIZE OF BIOG. FIRE SPflINKLERS R20'0 <br />OCCUPANf,y�OAD FlREAL4pM REO'D <br />I�ITAKE BY <br />DATE <br />FPPROVEDBV <br />$ <br />_ �� <br />cirv <br />CItY <br />CIiV <br />CITY <br />� ,�.J....�y d� 7 — U.:� /ai� <br />ZIP PHONE <br />Z�P PHONE <br />Z�P GHONE fTqTE LICENSE I <br />Z�P9�Q3� PHONE STATELICENSEM <br />w-oS? � %%S�-Ao3/ SoEiiL//f <br />Z�P PNONE STATE UCENSE s <br />C..ATACT PERSON AN� PNONE NO <br />i HEREBY CERTIFY THAT I FIAVE READ AND FXAMINED THIS <br />APPLICATION AND KNOW THE SA�NE TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFI=D HEREIN OR <br />NOT. THE GRANTING OF A pERMIT DOES NOT PRESUME TO GIVE <br />AUTHORI'Y TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />pTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEAFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APP:.ICATION IS MADE AND I COMPIY WITH THE STATE <br />C�NTRACTORS LAW 1&.27 RCW AND 296200 WAC. <br />x_�� a-�y�9 � <br />SiG R %���i/S/ DAIE <br />TYPE OF EQUIPMENT <br />!VC—A/HNDLG UNITS--H.P. <br />�ORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DFiYERS <br />VENTILATION FAN <br />WATER HEATE <br />WOODSTOVE <br />METAL FIREPL <br />FIAEPIACE INI <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SII`C;EiP�GK PLANCHEGKNU618ER <br />VACFNT SIiE FEES <br />L, YES ❑ NO BUILDING <br />acu�nucr �mcvowmrv,uxirs <br />4F0�> <br />PLUMBING <br />B�SEMENT <br />_1 YES .'" j Np MECHANICAL <br />HEIGHTUMRATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUIIDING SURCHARGE <br />CITY OF EVERETT pUBLIC WOFHS <br />LOCAL SALES <br />TAX COUE IS 3105 TOTAL <br />SUBTOTAL $ sU <br />PERMIT $ FJT <br />TOTALFEE 5 ut <br />