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E <br />APPLICA'TIC-1 FOR CONSTRUCT"M PERMIT <br />TG BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑__ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING E SIGN <br />OWNER NAIL ADDRESS CITY ZIP PHONE <br />ski roles aj(jxz�'cr map f r- !�X62/L 60-z''Z5Z <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />rt)a =IN?[ftrnXJ-Ts (10C? gat o�`st- lrsn �Ic� 1 1 rr�a�i �18b�3 ?71- Z� <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />�- PHONE <br />STATE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK ANOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />�T5���� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE 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 18.2 RCW AND 296.200 WAC. <br />PROPOSED USE OF UILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT— BLOCK OF '— <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />- StAl- <br />PROJECT ADDRESS r <br />BIGNA UPE DATE <br />CITY BUSINESS LICENSE NO. <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 />I <br />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT S <br />I <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: nu&4 7,W) 17A0%/i f;-O&T:OV�d ,afc," C%Z-.,' [ /5-/Z-aI% <br />FRONTSETBACK <br />REARSETBACK <br />VWESETBACK <br />Z�j <br />PLAN CHECK ER <br />FEE /_ <br />Cv <br />IECEI�O-� <br />U <br />CnJL/.% <br />D <br />o(f <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />VJ9'�100 <br />y- 23 / 170 <br />El <br />wOugnS <br />TYPE OF LO <br />S . <br />NO. OF STORIES <br />CC� CYE$ <br />xD. W DWCI <br />/27 <br />}raj <br />PLUMBING <br />s�z qq��BLOG <br />+ <br />FIRE SPRINKLERS RED <br />BASEMENT <br />MECHANICAL <br />--�� <br />ZqF <br />❑ YES R NO <br />ADDITIONAL PLAN CHECK <br />I <br />T <br />OCCUPANCY LOAD <br />FIRE ALARM RED D <br />HEI TLIMITATION <br />? <br />(6-i7 <br />i% <br />ER <br />I <br />REASON <br />/}� n1 rNMI vG %�/Gp �IC�`� <br />YYIM1/C/ 7- <br />/ TATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS J?PROVEED'BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />DATE �l Z' qc%' <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />23 2 <br />