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APPLICATIC'�] FOR CONSTRUCT��'1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ _ f <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL LUMBING O SIGN <br /> 011��n��� MAILAO�55 n �� CITV /J p //JOO� PHONE <br /> , <br /> �-� �1l –�c �-��^ a <br /> TENFNT MAILAOORESS CITV ZIP PHONE <br /> !,J l�d r3r2n s vnrcrwt�,��i EvP�✓�ze.q I,J,r �vr' <br /> AFiCHITECT OR OESIGNEfl IAAIL ADORE55 � CITT` � ZIP PHONE <br /> GENERALCONTRACTOR MAILAOORE55 CITY 21P PHONE STATELICENSE� <br /> MECH�NICALCONTRACTOR MAILADOflE55 CIN ZIP PNONE STATELICENSE� <br /> PLl1MBING CONTRACTOR MAIL ADURESS CITY ZIP PHONE STATE LICENSE/ <br /> - ra � oM LNC M S�,<< 9 S3- if � �.,� o v <br /> CONTRACT PRICE OF WORN <br /> �� ' <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON�ND PMONE NO. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDESCPIPTIONOFPROFERN�fti0WN8ELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLGCK-- OF 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 BV THE <br /> OW R OF THIS PROPERTY 0 PERFORM THE WORK FOR WHICH <br /> PARCELTA%I.D.NUMBER APP�CATION IS MADE D I COMPLY WITH THE STATE <br /> CON RACTORS 18.27 C AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER,ADDRE55.TELEPHONE NUMBER j /� <br /> / <br /> PROJECT ADDRESS sicnaruae �� <br /> � � CIiYBOSMlSSLiCC.NSENO <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATEFi CLOSET(TOILET) � A/C—FUHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWEii ' CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> UISHV�ASHER RANGE HOOD � � <br /> LAUNDRY TRAY ; WATEFI HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> UR�NAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINK�NG FOUNTAIN � FIREPLACE INSEFiT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � , � <br /> T <br /> � 1 <br /> SUB TOTAL S ' SUB TOTAL $ ' <br /> PERMIT 5 PERMIT 5 � <br /> TOTAL FEE 5 ' TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: SSLA � <br /> FRONT SETBRCK REAR SETBACN SIDE SEiOACN PLAN LH CK N��6�BER'y' � FEE RECEIPT NO. <br /> t ,� ` <br /> uSezoNe LOTAREA VACANi51TE FEES VALUATION FFE <br /> ❑ YES .—J NO BUILDING � <br /> IYFE Oi CONSi. NO.Of STORtES OCN°u�n �;o oF�v;iw46bsns � <br /> C9p��" PLUMBING i�b <br /> SIZE OP BLDG. FIPE SPRINNLERS REO'D BASEh1ENT MECHANICAL ' D <br /> G YES '-! NO � <br /> OCCUPANCVLOAD FIREALARMREOD HEIGHTLIMITATION ADDITIONALPLANCHECK i <br /> i <br /> OTHER � <br /> REASON i <br /> STATE BUILDING SURCHARGE � <br /> 111TAKEOY FLANSAPPROVEDOV CITY OF EVERETT PUDLIC WORKS � <br /> LOCALSALES , <br /> DATE TAX CODE IS 3105 TOTAL J � p� <br />