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APPLICATI� FOR CONSTRUCT�N PERMIT � <br />TO BE CuMPLETED IN BLACK INK—PLEASE PRIh i <br />S�"'� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION CJ COMBINATION � BUILDING ❑ MECHANICAL <br />OWNER MAI�ADDRESS <br />. / _ _ <br />CITY ZIP <br />CITY <br />U � <br />PHONE <br />❑ SIGN <br />RRCHITECTGRDESIGNER MRILADDRESS CITY 21P PNONE <br />,$�,r,o%L,,,:r�C'o�,..'� �a'/�enr /i7�� aS''� A�e s�. E.•�cr,, 9F,zv� �3�--��sZ- s,�cN�eBi�z�Qy <br />GENEML CONiqACTOR MRIL AODRE55 CITY 21P ' pHONE STATE L�� 5���� <br />MECHIINIGA�CONTflACTOfl MAILADDRESS CITV 21P PHONE STATE�ICENSEII <br />PLU/MB�INGCONTqRGTOR MAIIADDHE55 CITY <br />CONTRACT PRICE� AK <br />�/7 �'f o <br />OESGRIBE WORK �ND SOUARE FOOTAGE INVOLVED <br />T ,;�./e,� K'is.�� a- �TM eM�.�i <br />�r r Oi4,�s.�L��R K,•����,�f�,e��ti <br />PflOPOSED USE OF BUILDING <br />'f/etu /11ASa.t/� � /�¢w�-.!0%Q _ <br />LEO�IDESCRIPTIONOFPROPERTY[�S,/H�OWN LOWORATTACNTWOC�OPIE/�S�)�(�' <br />LOT O �O� BIOCN —�— OF ��=� <br />6a6.z Ocn.. <br />! .. L ] -lSil] � <br />PARCELTAXID.NUMBERr <br />G o6i-Ooo- <br />CONSTRUCTIONLOANlENOEN.ADDRESS.TELEPHONi <br />PLUMBING ' � <br />NO. TYPE OF FlXTURE OR ITEM <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK <br />FOR OFFlCF USE ONLY: <br />FRONT SETBALK REAq SETBACK <br />USE 20NE <br />lYl'E OF CONSI. <br />SREOFBLDG. � <br />3�13�1� T.I . <br />OCCUPANCYL AD <br />rf � <br />PEr150N <br />02� <br />'/- d �U <br />FEE <br />SUB TOTAL $ <br />PEfiMIT $ <br />TOTAL FEE $ <br />LOTAREF <br />NO.OF STORIES <br />FIRE SP �INKLERS REO <br />� N� <br />FIRE R EO'0 <br />� <br />��2vED BY <br />j�� � <br />SI�E SETBACK <br />0 <br />liP <br />COYTACT PERSON AND PHONE NO. <br />� <br />337-/7SL <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TNE 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 THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x�'la��.�`J�too.v��v�.,� 9- �o- 5',3 <br />SR'.rv�iURE '� o•re <br />CItY BUSMESS ULENSE IHI. <br />TYPE OF EOUIPMEN7 <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPIACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />VACANT SITE YGCS <br />C.7 VE& � f� NO BUILDING <br />OCCyP1M[Y NO.IX01VflLINGUx115 <br />3" �°� iX PLUMBING <br />F� <br />BA EMENT MECHANICAL <br />o vEs ,1t No <br />HEIGNTLIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STA7E BUILDING SURCHAR3E <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES — <br />reY r.nnF �s a�n� TOTAL <br />SUB TOTAL $ <br />FEE <br />i <br />X <br />e <br />