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APPLICATIW4 FOR CONSTRUCT -ON PERMIT <br />�l/T�lnOBE COMPLETED IN BLACK INK —PLEASE PRINT <br />I 141 � I µv BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC I U L ,1 tlr <br />259-8810 \ ' <br />1 l DEMOLITION I I COMBINATION 1 1 BUILDING I I MECHANICAL PQPLUMBING I SIGN <br />04NIER MAIL ADDRESS CITY ZIP PHONE <br />IENANT MAIL ADDRESS CITY ZIP PHONE <br />AtiCftIIECT OR DESIGNED MAIL ADDRESS CITY ZIP PHONE <br />PLUMBINGCONTRACTOR <br />(1uiu z <br />MAR ADDRESS CITY ZIP <br />c /b��FvuE <br />MAIL ADDRESS Gllr 11 <br />MAIL ADDRESS CITY ZIP <br />PHONE STATE LICENSE <br />�9_9� sDc d **� <br />PHONE STATE LICENSE N <br />PHONE STATE LICENSE e <br />J'[11�-�CK, ►3eo /d <br />CONTRACT PRICE V,ORK <br />13"t <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PL RSON AND PHONE NO <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICANON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWC AND OPDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETEU 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 1 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 (11822777 RRCCW�W AND 296,200 WAC. <br />xxh�7�7G(/'• 9� <br />sX;Nm LIRE � o�I��r <br />PROPOSED USE OF BUILDING F GE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT— BLOCK of <br />- <br />PARCEL TAX ID NUMBER <br />CONSTRUCTIOqLOAN TENDER. ADDRESS. T[LEPIIONE NUMBER <br />PROJECT ADDRESS r 1 <br />�7,j / 7 <br />cnrnusrtrLss LmeN.r rm <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />,r <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />0.7 <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />�- <br />1G_ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />},� <br />7 <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />7:4:7 <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />r <br />HEAT PUMP <br />�— <br />O <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />U <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />�— <br />C <br />SINK (SEP'VICE—BAR. ETC.) <br />T— <br />I <br />I <br />SUB TOTAL <br />$ <br />' <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />�— <br />FOR OFFICE USE ONLY: lv�y- <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAIT CHECK NUMBER <br />TEL <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />f. YES rl NO <br />BUILDING <br />— - --- - -- — <br />i <br />TV" Of CONST <br />NO. OF STORIES <br />mr mN[r <br />tO M nMUMINITS <br />— -- <br />cnas <br />I <br />PLUMBING <br />' <br />SIZE OF BLDG, <br />FIRE SPRINKLERS RED'D <br />BASEMENT <br />MECHANICAL <br />i <br />(l YES El NO <br />ADDITIONAL PLAN CHECK <br />; <br />) <br />OCCUPANCYLOAD <br />FIRE ALARM REDO <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANSAPPROVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />) <br />LOCAL SALES <br />TOTAL <br />DATE <br />TAX CODE IS 3105 <br />