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APPLICATIC 1 FOR CONSTRUCT' IN PERMIT 0; <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT `- <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION <br />HEATING SYSTEM: U GAS J' ELECTRIC U <br />1 BUILDING <br />I I MECHANICAL 11 PLUMBING I I SIGN <br />CITY ZIF <br />73 s r.:x <br />CITY ZIP <br />rrwmc <br />353- <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />Cm "I ..._.._ <br />GENEMICONTMCTOR PHONE STATELN:ENSEI <br />MAIL ADDRESS <br />CITY ZIP <br />........ FTATF I ICENSE <br />of <br />clvWia!j <br />MAR <br />CONTRACT PRIC? OF WORK <br />/4 <br />DESCRIBEUESCRIBE V <br />ADDRESS <br />I/ <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAXI D. NUMBER <br />QONSTRUCTKNILOANLENDER. ADDRESS. <br />5 T" Sc <br />A DISP <br />SINK (SERVICE -BAR. ETC.) <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SET <br />.._. ....� LOT AREA <br />TYPE Of CONSI <br />SIZE OF BLOC <br />INTAKE <br />FlRE SPRINKLERS REOD <br />FIRE ALARM RED D <br />PLANSpLANS APPROVED By <br />DATE <br />E <br />SIDE <br />,IF <br />STATE LICENSE <br />LITY ZIP PHONE <br />CONTACT PERSON AND PHONE NO. <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 TYPE 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 STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF IS <br />WHICH <br />APPLICATION IS PROPERTY <br />PERFORM <br />A DICOMPLY WO <br />RK <br />HER STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />GAS <br />FAN <br />D <br />T.U. <br />SUBTOTAL S <br />PERMIT $ <br />TOTAL FEE E <br />❑ YES ❑ NO <br />BUILDING <br />— <br />OCLNAtCY <br />Ic apvtulwuVire <br />caaro <br />PLUMBING <br />SASEFENT <br />MECHANICAL <br />❑ YES ❑ NO <br />---'� <br />PUN CHECK <br />NEN3NT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />