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m <br />APPLICATIf`V FOR CONSTRUC"f�-7N PERMIT � <br />,`� .. TO BE COMPLETED IN BLACK INK—PLEASE PRINT E+" T� <br />' � HEATING SYSTEM: GAS CJ ELECTRIC J -1 <br />BUILDING DEPARTMENT�. . <br />259•8810 <br />❑ DEMOLITION I I COMBINATION ❑ BUILDING 'dx'MECHANICAL I-I PLUMBING CI SIGN <br />OWNER MAILAUDRE.S 1 CIiY ZIP PNONE <br />Fr'IiAi`Ir�� I�ivnQi��(iPZ �i 11^. ����1 l�v� ;i F_ F�'r ;c'� �� t' �O(� 3�-1 "I �6 d.3 <br />TENANi <br />pFCHITECI OR OF.SIGNER <br />GENERALCONTRACTOR <br />'AECHPNICAL GONiRACT : <br />Svr��d'�(J LY <br />MM��DORE55 <br />MAIL AU�flE55 <br />MAIL AOOPE55 <br />I1(n��o Sla <br />tAAIL �DORFSS <br />CIiV 21P <br />CITV ZIP <br />CITY 21P <br />CITY ZIP <br />���'���.. �i�iI:IQ�Y,� �i <br />CONTRACT PflICE OF WORK <br />a?��i � - <br />DESCRI�E WOflK AND SOUARE FOOTAGE INVOLVEU <br />'7 t,Skr� �� cxn S-�� �-c n1a cc.. L-��S('r-}- <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW OR Ai1ACH 1W0 COPI[5� <br />�or-- eiocK oF <br />PARGEL'.A%I.D.NUMBER <br />(�4oa- �o��- C�nS-O<�0�; <br />GONSTPl1CTION IOAM LENOER. ADPRESS, TELEPHONE NOMB;R <br />1 i� 3 �l a�� n;- s� c vP,-c.�i <br />PLUMBING <br />NO. TYPE OF FIXTURE OR 17EtA <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATOFlY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & UISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOON DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVlCE—BAR, ETC.) <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETDACK REAflSETBACN <br />USEZONE LOTAREA <br />iVPE0FC0115L NO.OFSTORIES <br />SIZE OF BLOG. FIRE SPRINNLERS REO'D <br />OGGIrFANCVIOAD FIREALARMPEO'D <br />NEASON <br />INTAKE BV P�ANS APPROVED OV <br />DAiE <br />CITV ZIP <br />FEE <br />� <br />PHONE <br />PHONE STAiE LICENSE 9 <br />PHONE STFTE LICENSE Y <br />833—�rvs-y 5�tic.c <br />FHONE STATE LILEt.SE N <br />COIJTACT PERSON AND PHONE NO <br />a����r�c���_i E �c�;,,q �'�-3-y����sy — <br />I HEREBY CERTIfY THAT I HAVE READ �ND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPF OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NO? PRESUME TO GIVE <br />AUTHORITY TO VIOLAT� OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTfiUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OINNER OF THIS PROPERTY TO PERFOFlM THE WOFK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAl'J 19.27 RCW AND 296.200 WAC. <br />- 1�., , „ ,:, , : . . ii . - �Di r C� ; � � <br />NO. TYPE OF E�UIPMENT FEE <br />AIC—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />UNIT HE�TERS—B.T.U. M � <br />CLOTHES DRYERS —T <br />VENTILATION FAN <br />RANGEH000 <br />WATEH HEAI�ER � <br />WOOD STOVE <br />METAL FIREPIACE (WOOD 6URNING) ' <br />� FIREPIACE INSEflT � <br />HEAT PUMP <br />GAS PIPING � <br />� <br />EXHAUSTFAN ' <br />SIDE SETBACK PLAN GHECN NUId6EN <br />VACANT SITE FEES <br />n ves n No BUILDING <br />a�urnncr u—Tourmvmincw�us <br />cnour I p�UMBING <br />� <br />BnSEMENT �dECHANICAL <br />f7 YES ❑ NO — <br />HEIGM� UGIITATION �D�IiIQNAL PIAN CHECK <br />OTHEfl <br />STATE OUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX COUEIS 3105 TO7AL <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE $ <br />PECEIPT N0. <br />i <br />� <br />• <br />