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�. <br />APPLICATIO_. FOR CONSTRUCT( �N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT �EATING SYSTEM: �I GAS ❑ ELECTRIC ❑ <br />259-881p <br />� DEMOLITION � COMBINATION X BUILDING �C.MECHANICAL XPLUMBING 1 SIGN <br />OV/NEft MAILADDRESS CITY 21P PHONE <br />i.f " " <br />q IAAIL <br />DESIGNER MAIL <br />CITY <br />CITV <br />ZIP <br />ZIP <br />GENERAL CONTflACTOR MAIL RDDRESS � �IiV : 21P PHONE STATE IIGENSE a <br />� <br />MECHANICALCONTRRCTOR MAILAUOPE55 ��0� CIT� 21P PHONE STATELICENSEa <br />�J S AIE�',�i,✓i��� <br />PLl1MBINGCOdTRACTOR MAILADDRESS CITY 21P PHONE STATELICENSEs <br />CONTRFCT PRICE OF WOFK <br />_/'LSa 00 <br />�f�$ffil EWORKAIQBfOUAREFOOTAGE <br />PROPOSED USE OF BUILDING <br />�.SiDEd« <br />LEGAL OESCRIPTION OF PROPEflTY �SHOWN dELOW OR AiTFCH TWO <br />�or /6r �/L e�ccK -+�_ oF �Il,,, v.G <br />PARCELTAXI.D.NUMBEP <br />CONSTROCT104 LOAN LEN�E(7. ADDRE55. TELEPHONE NUhiBEq <br />TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />6ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK9-B{6P-+ <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADER; <br />SINK (SERVICE—BAR. ETC.1 <br />PERMIT <br />FOR OFFICE USE ONLY: <br />FRONTSETBFCK REARSETBACK <br />USE ZONE <br />TYPE OF CONST. <br />51[L OF BLDG. <br />OCCUPANCYLOF.D <br />P.EASON <br />INTAKE BY <br />IOTAREA <br />FIqE SPflINKLERS flE0'D <br />PLANS APPi:OVED BY <br />OATE <br />$ <br />PERSON AND PHONE N0. <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 TVPF OF <br />�� WORK WILL BE COMPLETED WITFI WHETHEFi SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PFRMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORR7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TNIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.2 AND 296.200 WAC. <br />/ <br />SIG iURE pI L _ _9 � <br />� <br />� <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRYERS � <br />VENTILATION FAN <br />RANGEHOOD , <br />WATER HEATER � <br />WOOD STOVE ; <br />METAL FIREPLACE (WO00 BURNING) � <br />FIREPLACE INSERT <br />HEAT PUMP � <br />GAS PIPING � <br />EXHAUST FAN � <br />PIAN CHECN NUMBER <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />acw�xc rm orowEuixcuars <br />4P0pP PLUMBING <br />dASENENT MECHANICAL <br />C YES ❑ NO <br />HEIGHTL'MITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING Sl1RCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FEE I RECEIPTNO. <br />