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APPLICATIO. . FQR CONSTRUCTf"��N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEM��LITION � <br />TENANT <br />ARCHITECTORDESIGNER MAILFDDRE55 <br />GEpIERFLCONTflACTO.�R - MAILADJ� ESS <br />�llCr //C%'�h� L"Or�S <br />MECHANICALCONTRACTOR MAILA��RE55 <br />PLl1MBING CONTflACTOR MnIL AD�RESS <br />COVTPACT PRICE OF WORN //^ q�� <br />� V <br />UESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />J <br />/��/'/'.�C �ti9 , �%�/l <br />HEATING SYSTEM <br />❑ BUILDING <br />��r� <br />��� �!>'c ; � <br />y�" �/� _ <br />❑ ELECTRIC ❑ I <br />❑ MECHANICAL O PLUMBING � SIGN <br />� � �/' �,�rr' , ,,� � <br />;� /� � � -, <br />�l�«�r i�� �/_��, � ���- <br />ilP / PHOy� <br />%�-'"'rr//: _ ., !/%i�J %�,7%C� �/7��'�'�� <br />CITV /� q ZIP <br />/Y�'ll�/��%� ��:1j(/� .Jj�C� <br />CITV y ZIP : <br />�j���='F f/ ��f <br />an zia <br />S' <br />' PROPOSEDUSEOFBt11LDIN �_ <br />S� �% <br />' LEGAL DESCPIPTION OF PRJPERTV (SHOWN BELOW JR ATTACH T40 COPIES) <br />� LOT BLOCK . OF —J ._ . <br />2 <br />� <br />� <br />TA%I.D.NU BER <br />322� `��" D/3 - 0.3�� <br />Ur,TION LOAN LENDER, ADDRE55. TELEPHONE Nl1MBER <br />'�.CT ADDRESS 3 �/ S �� ,_ �— <br />�-- <br />IMBING <br />TYPE OF FIaTURE OR ITEM <br />� WATER CLOSET�TOILET) <br />� BATHTUB <br />r LAVATORY(WASH BASW) <br />SHOWER <br />KITCHEN SINK & DISP <br />D!SHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SIDIK (SERVICE—BAR, ETCJ <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN flEAPSEiBACK <br />I15EZONE LOTAREA <br />TYPEOFCONST. NO.OFSTORIES <br />�j 2 <br />SIZEOFB DG FIRESPRINK�ERSFEO'U <br />�02�•* t k /f/G <br />� <br />OCCUPANCV LOPD FIFE ALARId OEO'D <br />INTAKEBY PLANSAPPROVE�BY <br />�M <br />onre l;l�r�lf� <br />PHONE <br />S�?-, <br />STATE LICENSE C <br />=/-'�.� � <br />STATE IICENSF. M <br />CONT �� PERSON ANO PMONE NO. %/j� �� �� C <br />\/!/ <br />i HEREBY CERTIFY'.'HAT 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 Tf115 TVPE 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 STA7E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CUNSTRUCTION. THAT I AM AUTHORI2ED 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 LA j 27 RCW AND 296.200 WAC. <br />� _' <br />Y �i � GCC'G�', Sy�� �/ ��i <br />TYPE OF E�UIPMENT FEE <br />A/�AIHNDLG 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 (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />$IpESET�ACN PLANGHEC NUMtltH <br />5�3 <br />VACANT SRE FEES <br />❑ YES ❑ NO BUILDING /� �Yj%j� <br />OCLpPANtv NO OfOWElUN6U�11i5 <br />cxauv i pLUMBING <br />� <br />BnSEMENi MECHANICAL <br />� YES ❑ NO <br />MEIGHT LIMITATION AUDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAFiGE <br />CITY OF EVERETT PUBIIC WOFKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAI <br />PERMIT <br />TOTALFEE <br />FEE jl^1�����` I RECEIPTNO. <br />�j� <br />ZZ <br />. <br />