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APPLICATIQ"'. FOR CONSTRUCT'"1N PERMIT � <br />� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � <br />259-8810 <br />I 1 DEMOLITIqN f! COMBINATION <br />OWNEF MNlAODRESS <br />d1.�o�t•c .�o o�sP ?rzo oL <br />iCNANT MAILADDRESS <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />h BUILDING <br />Crtv <br />c �///� <br />CITY <br />! ! MECHANICAL <br />Zm <br />.e.�,. �r 9� � <br />iiPLUMBING <br />� I SIGN <br />P.FCHITECTORDESIGNER MAILhDDRE55 CITV ZIP PHON[ <br />W��,�r�l'o �,Qu'/c1en.1' /i7�� �S'6 A�ir �C'. Gtve.,cTi,�'F.iv� �3�--i7SZ S,�eh'xB/s7-� <br />GENERALCONiRACiOR IAARpDDRE55 CITV 2�p �_ pHONE STFTEUCENSC• <br />iz-i-93 <br />MECMANiCALCONTqACiOR IAAILADPRE55 CIiV ZIP PIIONE £,ATELICENSEe <br />PLUTApINGCONTRACTOfi MAIIAODRESS CIiY ZIP PHONE STATEUC[NSEe <br />CONTRACT PRIGE OF WORN <br />DESGRIBE WORK AN� Soua1 <br />INVOLVEO <br />/7�f b <br />� f�4irf.�dir.tlQr�/�l1��/CL.N/'a� <br />PROPOSED USE OF OUILf11NG� <br />'vew �JASe.v� c %?w..,p�P <br />LEGAL UESCRIPiION OF PROP[RTV (SIIOWN LOW 08 ATTACH TYO COPIES) <br />�QT O�O V BLOCK L— OF �� R�� <br />OG�-oy/'O2�/ <br />PAPLEITARID.NUMBERC <br />� o6z-000- oy/- D�U <br />CONSTRUCTiON LOAN LENDER, A�DBF55. TELLPHONE NUMBER <br />LAVATORY <br />SHOWER <br />iINK 8 DISP <br />1ER <br />TAnv <br />UFINAL <br />DRINKING <br />FLOOR DRP <br />BACKFLOW <br />ROOF DRAII <br />SINK (SERV <br />FOR OFFICE USE ONLY: <br />fRONiSETBACK REAR SFiBACK <br />USEZONE �UTqREA <br />TvrE ov c�orv7s-i�� � <br />-V�lll <br />SRE OF �LDG. <br />3`13`7�� T' <br />REASON <br />INTFKE BY <br />SUB TO L $ <br />PERMIT $ <br />TOTAL FEE S <br />� <br />FIRE SPRINN�EFS REO'D <br />No <br />PLANS �PPROVE� BV <br />on.e �%�n�a.� <br />COqTALT PEFSON AND PNONE NO. <br />�37—/7SL <br />I HEREBY CERTIFY THAT I FiAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLElED WI'i:i WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CA�CEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZE� BV 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 1827 RCW AND 296200 WAC. <br />x7��� q.lJ�-odv�e�s.� 9' � o— 5'_3 <br />s���ar��� o„E — <br />TYPE OF EOUIPMEN' <br />AiC—A�HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRVERS <br />VJOOD STO' <br />METAL FIRE <br />FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />El(HAUST R <br />SIDE SETBACK � PLANCHELK Nt1MB[R <br />vncnHtsrte � FEES <br />� 1 YES :l NO BUi�DiNG <br />acunaytt xoarowF�oricuvqs <br />r,a <br />1� gy �' PLUMBING <br />Bn EMENT AIECHANICAL <br />VES X NO <br />MEIGMT UMITnTION ADDITIONAL PLAN CHECN <br />OTH[R <br />STAT[ �UI�DING SUflCHARGE <br />CITY OF EVERETT f'UBLIG WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />SUE TOTAL y <br />PERMIT $ \ <br />TOTALFEE 5 � <br />F[E RECEIPTNO <br />/��6� /J�<,—�G <br />�O <br />✓ <br />