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A PLICATIC-1 FOR CONSTRUCT"IN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT ry <br />HEATING SYSTEM: GAS ❑ ELECTRIC J <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION' I.I BUILDING ><MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNE/p %� / M DRESS /C/FFV /L ZIIP- /] 7 P/HO/ E ' / �j� /_ <br />/ n .�..,., / 1... /., 7n�s, /7T�i'f zly, i� 9H /i l% �JO oT 3`/ 7- �%'OII a <br />TENANT <br />NAIL ADCRES9 <br />CITY ' <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHCNE <br />STATE LICENSER <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE N <br />2cvuDrnoulaxdol►�L <br />$3S� _E7vT>zp� <br />#137ke7L'T <br />9863Z <br />SS4844I <br />.412CoCz131I <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CIT" <br />ZIP <br />PHONE <br />STATE LICENSEp <br />CONTRACT PRICE OF RK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLV D <br />eQ G� cs�T' S' E = f (o <br />CONTACT PERSON AND PHONE NO. <br />y E <br />3 <br />) E <br />6 Lo0Cr � 854-Sq4 <br />F 7VILET gr:�Y% <br />UCFCA-)6 _k_ <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />UING <br />PROPOSESE OF BULL DING <br />P <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />iriATT,Vo o Y <br />PROVISIONS OF <br />LEGAL DESCRIPTION OR PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT- Bl. (r OF <br />c l <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOCAL LAW REGULATING CONSTRUCTION OR THE <br />CvtQ <br />OTHER STATE OR <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 296.200 WAC. <br />X kotah <br />PARCEL TAX I.D.NUMBER <br />CONSTRUCTION LOAN LOAN LF NDEIi, ADDRESS. TELEPHONE NUMBER <br />PROJECT AD E1SS <br />Sc� Fj lAll <br />lft <br />slcrvauRE.z.L3p'.3 DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />:jam <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />AM <br />NO. I <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET).- <br />I <br />AIC—AJHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN)'. <br />I <br />3 <br />UNIT HEATERS—B.T.U. M <br />SHOWER $�! <br />CLOTHES DRYERS <br />KITCHEN SINK R DISP. <br />VENTILATION FAN <br />.DISHWASHER 49-. <br />RANGE HOOD <br />LAUNDRY TRAY 2.. <br />WATER HEATER <br />'MF <br />CLOTHES WASHER" <br />WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) i'IN <br />URINAL; <br />DRINKING FOUNTAIN <br />.* <br />tti ; <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR. ETC.) <br />I <br />' <br />T <br />I <br />' <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />' <br />I -UK UrrRit UOr. <br />FRONT SETBACK <br />VPILT: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK N)1MBER/ <br />1-9 <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />NO. OF STORIES <br />GWOVANtY <br />GROUP <br />No ov OWFLLMC UNITS <br />PLUMBING <br />' <br />MECHANICAL <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />A <br />Fl <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE II �j �'� <br />CITY OF EVERETT <br />LOCAL SALES <br />CODE IS 3105 <br />TOTAL' <br />