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APPLICATIC�1 FOR CONSTRUCT"�!N PERMIT � <br />n��/ TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />1 <br />BUILDING DEPARTMENT HEATWG SYSTEM: I�GAS U ELECTRIC �.l � <br />259•8810 <br />I 1 DEMOLITION ! COMBINATION I i BUILDING i MECHANICAL I�LUMBING i� SIGN <br />OWNER MAIL �DONE55 CIiV 2iP PHONE <br />3i1�fV 16V�I I�DIUES ( iZD 121ST 3'f sE ��'; P� EVE2ETT� Ull�-�- �l�D� <br />TENANT M4LLRDORESS CITV 21P PHOnE <br />�RCNITECTOROESIGNER IARIL�DDRE55 CI1V ZIP PNON[ <br />GENEMLGONTR�CTOH M�IIADD{1E55 CIiY ZIP PNONE S7�TELICENSE� <br />MECHANICAL CONiR�GTOH M�IL �O�RESS <br />YUL AODf1E55 <br />I�L. <br />CONTRACTPRICEOFWORK �I���.� <br />�ESCRIBE WOHN �ND SOU�RE FOOiROE INVOIVE� <br />'�D IN�JfAI.I. �� pl_Q�N�j,�� T .�T <br />L�, PI c� Ta p�r�c-,�s (z) ►�NP F, P <br />PAOPoSEOUSEOFBWLOMCi �� <br />�EOAL DESCRIPTION OP I'RJPER7V �SHOWN BELOW ON ATi�CN � WO COPIESI <br />LOT BIOCK OF <br />PRRCELTA%ID NUMBER <br />CONSTRUCTION I UN IENDEN. �ODRESS. TELEPHONE NUMBEH <br />N0. TVFE OF <br />WATER CIOSET� <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAV <br />CIOTHES WASHER <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFL roN PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SEfiVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONTSEiBRCN RE�NSETB�CN <br />u5E 20NE <br />IYPE Oi WN51 <br />SIZE OF BIOG <br />OCCUP�NCVIOA� <br />RE�SON <br />INiRNF 9V <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />LOiARE� <br />NO OF STORIES <br />FlRE SYRINNlERS REOD <br />FlflE �L�RM RE00 <br />PlRN54PPROVEDBY <br />nnrr <br />SIDE SEL94CM <br />CRV ZIP PMONE ST�TE LICENSE � <br />CITY ZIP P11pNE SiATELICENSE� <br />I�ae.o���i41� <br />CONT�CT PEPSON RND PNONE NO <br />i HEFEBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TR'JE AND CORqECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GPANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE Ofl LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM ;,UTHORIZED BV THE <br />OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOF WHICH <br />APPLICATION I� MADE AND I COMPLV WITH THE S�ATE <br />CONTRACTOP . L"JV 18.27 qCW AND 296.200 WAC, <br />x,�,a,i� �i ��- 4-2-43 <br />sMrumnr w*[ <br />O�vqi6u1fS5UCf�Nst �x� <br />!vC—A�HNDLG UNITS—H.P. <br />PORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />RANGE HC`OD <br />WATER � �EATER <br />WOOD :�TOVE <br />METAL FIREPIACE (WOOD BURNINI <br />FIREPLACEINSERT <br />GAS PIHING <br />EXHAUSfFAN <br />V�L�NT SITE FEca <br />��' VES . '. NO BUIIDING <br />OC[VMMv NOMpVlIU45v4i15 -- <br />cxao pLl1MA1NG <br />B�SEMENi MECHANICAL <br />� � YES ! 1 NO — <br />HeicHruMrtnnoN �DD7710NnLPLANCHECK <br />OTHER <br />STATF DUILOING SURCHARGF <br />CITY OF EVERETT ruauc woaKs <br />LOCAL SR�ES <br />TAX CODEIS 3105 TOTAL <br />� <br />RECEIPT NO <br />�_._ ';"`31 <br />' ' ,.1; <br />T <br />� �.�ic <br />T a�� <br />�. <br />, ^S <br />� `'I <br />T- �'.{.. <br />; < <br />T � �iV. r <br />a <br />� <br />