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� <br />APPLICATIC�1 FOR CONSTRUCT�I� PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEA7ING SYSTEM: �j'GAS �] EIECTRIC :J <br />259-8810 <br />DEMOLITION )( COMBINATION X BUILDING X MECHANICAL )( PLUMBING SIGN <br />OY/NER M�I�ADDRE55 �ITY ZIP PHONE <br />J v�i.z�l �'o k5 „ki��/! l� C /SG)�� +�x ei'tiJ �l/G �fjf� i�/ �.a[G l fjfi3 c�)i1 <br />iENFNT 1,UI� pDDNE55 �ITV zIP <br />VMONE <br />AR�HIiECTOfiDESIGNER MI1IL�DORESS <br />ZIP <br />GENENRICONTPIGTON M�II�DDRESS GITV ZiP FHONE�J'�p. �jj(�.�FII�ENSE� <br />\ �_�.. �� � V_ i� _�. _�.. "�"�.._ . � .._ "l� � . <br />mEGH�NiC�LGONiMCTOR I M�1L�DDRE% �ITY ZIP PNONE 51�TElIGENSE <br />�GR'4v✓1 /lt'c�itct r 3r � 1�'�•F • .� f.�n .�ei rilA. f'�a•; %�/S3')in .✓ •;zI/��J ct <br />PIUTABIHGL LHqCiOR MA�L 0 NE55 CIiY ZIP PNOHE STQEIICENSE� <br />AI1�1. �/,..��.:..r. .aevo m.../Nn... _�._ .._ ._.. ..� _ ..i a....... _�.. .o-,n .. _..- ----' <br />CONTq�LT PRICE OF Y/ORN <br />DESCRIBE WORK �NO SOU�RE FOOiAGE INVOLVED <br />l�-avi� � <br />PROPOSEO lISE OF BUIt01N0 <br />J � .ic 'c...� <br />LEWL�ESCF�IP% NOFPROPEPIY�SN01 <br />LOT�L BIOCN - <br />r <br />� <br />. , PAq�ELTA%10 NUMBEN <br />GOHSTNl1CITION LOAN LENOER. ADDRE55. <br />��1Q� r1 f n �lJ. � <br />PROJECT pDR � <br />PLU B N6 <br />NO. 7YPE OF FIXTUI <br />WATER CLOSET (TOILE' <br />. �_ BATHTUB <br />LAVATORY (WASH BASII <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />. LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />.OW OF RTTFGM iW0 COPIE51 <br />oF �!a., a j G R <br />NIrMBER <br />� <br />NO <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINEO THIS <br />APPLICATION AND KNOW THE SAME TO 6E TRUE AND CORRECT ALL <br />PHOVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIE� HEREIN OR <br />NOT. THE GRANTING OF A PERMIi DOES NO7 PRFSUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONF OF ANY <br />OTHER S7ATE OR LOCAL LAW REGULATING CONSTRUC710N OP THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMr�LY WITH THE STqTE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�ta. ��['• ��� /'�o - % � <br />5RN41� D�If <br />ITEM FEE N0. TYPE OF EOUIPMENT <br />NC—A/HNOLG UNITS—H.P. <br />' FORCED AIR SVSTEMS—B.T.U. <br />� UNIT HEATERS—B.T.U. M <br />. . / CLOTHES DRYERS <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK 1SEFVICE—BAR, ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCR REARSETB�GK <br />USE ZONEI <br />� l <br />IYPF Cf CONS <br />� <br />54EOFBlD <br />��iS� � <br />OCCUPANC� <br />� <br />RE�SON <br />WT�NE BV <br />/ <br />v <br />FIRE SVqINNlERS REOD <br />Pl�NS APP�OVED BY <br />Ji <br />o�ie � /��/9< <br />0 <br />f <br />$IDf SEtBT�N <br />;� � <br />WC�M SITE <br />-'. YES C NO <br />IXCUNy[r 40dpW[IPMGUM1�15 <br />� �` •YES '+�'NO <br />MEIGNI LIMITAlld1 <br />� LL � <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUOTOTAL E <br />PERMIT S <br />TOTAL FEE S <br />C8 NUMBER FEE R[CEIPT NO <br />33// Jn <br />BUILDING <br />PLUMBING <br />MECMANICAL <br />ADOIiIONAL PL!"I CNECK <br />OTHER r ��7 <br />STATE BUILDING SURCIIARGE <br />PUBLIC WORNS <br />TOTAL <br />8 <br />d <br />/ 7 �; C',l <br />'1 <br />