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APPLICATIG � FOR CONSTRUCT:"�)N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT L <br />259-gg10 <br />I1 DEMOUTION ❑ COMBINATION <br />HEATING SYSTEM: f� GA5 ❑ ELECTRIC ❑ <br />❑ BUILDING I"1 MECHANi�;AL ❑ PLUMBING ❑ SIGN <br />dTY 21P min.ic <br />TENqNT � fApILqDORE55 � � �J��'/ <br />//�/,, CITY ZIP PHONE —� <br />7� <br />ARCHRECTORDESIGNER ILADDRE55 CITY - <br />Z�F PHGNE <br />GENERALCONTRq�TOR MAILAODRESS GTV <br />Z�� PMOIJE STATE LICENSE a <br />MECMqNICAL CONTqACTOR MAIL pDDRESS CITV <br />/ Z�P PMONE ST�TE LICENSE a <br />�-�7.�,.�.1 f�i,✓L /.�Zcr> r�/.�,i __�/r�7T' 3�3-33W .S�k/iNo940c. <br />PLUl,!BING CGNTRqCI Jq MAIL ADORE55 <br />CITV ZIP PHONE STATELICENSEtt <br />CONTRACT PRICE OF WpRK <br />�S�DU <br />OESCRI9E WORK ANDSOUApE FOOTAGE INVOLVED <br />PFOPOSED USE (,� Bl11LDING <br />LEGAL DESCRIPTION 0�� I <br />��T— BI.00N <br />PARCELTA%IO.NUMBER <br />39G7 �3- c <br />GONSTRUCTIONLOANLENDER, <br />NO. <br />CONTFLT PERSON AND PHONE NO. <br />� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAIAE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF Li,VyS 1ND ORDINANCES GOVERNING THIS TYpE OF <br />�SNOWN�ELOWOqATTqCMTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT iHE GRANTING OF A PERMIT DOES NOT �RESUME TO GIVE <br />AUTHORI?Y TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAI. LAW REGULATING CONS7RUCTION OR TFIE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOFI<'ED BY THE <br />_ OWNER OF THIS PROPEqTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />_ 00�,7 CONTRACy�bRS LAW 18.27 RCW AND 296.200 WAC. <br />iESS,TELEPHONENUMdER �� i <br />LAVATORY(W4SH BI <br />SHOWER <br />KITCHEN SINK 8 DIS, <br />QISHWASHER <br />LAUNDRYTRAY <br />CLOTHES 4YASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONTSETOACK REFRSETOALK <br />USE].ON[ LOTAREA <br />7YPE OF CON57. <br />SRE OF BLOG. <br />OCCUPANCV Li <br />SUB TOTAL $ <br />PERAIIT $ <br />70TAL FEE $ <br />FIRE SPRINNlF.RS flE0'0 <br />FIRE ALARM REOD <br />INiAKEBY I PLpNSAPPROVEDBV <br />DFTE <br />FEE I NO. <br />FORCED AIR SYSTI <br />UNIT HEATERS--B: <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOU STOVE <br />METAL FIREPLACE i <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXhIAUST FAN <br />SI�ESETBACK �PLANCHEGK��UMBER <br />vacnNr sire FEES <br />!.=� VES ❑ NO <br />BUILDING <br />oaurz,sr n� ourov,Fuixcuxns � <br />G�QI:F <br />PLUMBING <br />BASEh1ENi <br />I.� YES L; NO MECHANICAL <br />aEiGirt unurqnoN /+DDIiIONAL PLAN CHECK <br />orHea <br />STATE BUILDING SURCHAR�E <br />CITY OF EVERETT pUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />B.T.U. M <br />M <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE g <br />FEE <br />