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APPLICATIC I FOR CONSTRUCT' <br />IN PERMIT <br />TO BE COMPLETED IN BLACK INK <br />—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS <br />ElELECTRIC <br />❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION ❑ COMBINATION Y_c BUILDING <br />IJ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP <br />PHONE <br />TENAM' MAIL ADDREL'S CITY <br />I-V � l Lf=� i,Zo J `Se 0uQ r*_J I, {vla ik <br />ZIP <br />LZ'P <br />PHONE <br />ARCHITECT OR DE!.IGNER MAIL ADDRESS CITY <br />ZIP <br />MiONE <br />GENERALONTC <br />Cell �CG *F-�Sf CITY <br />44CO 41LL� <br />ZIP <br />PHONE �/.Z657. STATE LICENSER y(',Q�ii O � <br />lA <br />-Italt <br />MECHA141CAL CONTRACTOR MAIL ADDRESS CITY <br />ZIP <br />PHONE STATE LICENSER <br />PLUMBINJ f. ONT:'•:TOR MAIL ADDRESS CITY <br />ZIP <br />PHONE STATE LICENSER <br />COHTF,CT PRICE OFF�WORK <br />1-LL <br />DESCRIB WORK AND SQUARE FOOTAGE INVOLVED x 116410kd_�C <br />CONTACT PERSON AND FFJNE NO.I^ <br />���pppILLLLLJJI��E000 <br />I�nP�o•+1�T�zr.rT ,=o-z A (IaL�SaLoN'. �e�r�Fil� <br />(vA� j -(-� <br />TK Iac 1�Ay✓�1�IV9 • -i-Isca ?L,Uk{3• E%� <br />E <br />I HEREBY CERTIFY THAT I PAVE READ AND EXAMINED THIS <br />PRCPOSEED GSE OF BUILDING <br />APPLICATI'-N AND KNOW THE SAME TO F' TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCE, I",'V=RNING THIS TYPE OF <br />WORK WILL BE COMPLETED WI" WHE-. H:Ji SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEIrJ,'IT DOEL NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />UOT BLOCK OF <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 18.27 RCW ND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER T� <br />a12�� <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />I. \ll�!`r/iiW l <br />OLT)1.. _ <br />PRO.IECT DDRESS <br />SIGNATURE PATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EOUIPMENT FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C-A/HNDLG UNITS-H.P. <br />) <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />T <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />' <br />VENTILATION FAN <br />) <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN_ <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I <br />' <br />I <br />I <br />) <br />I <br />' <br />SUBTOTAL $ <br />' <br />SUB TOTAL $ <br />I <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />t-UH UrrlL:e Llac <br />FRONT SETBACK <br />VINLT: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN �CKNUMBER <br />L <br />FEE !.3 <br />RE�PT�,,,, <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />000 <br />TYPE OF CONST, <br />✓� N <br />SIZE OF BLDG. <br />��GS t• I.� <br />NO. OF STORIES <br />FIRE SPRINKLERS REO'D <br />NJ <br />OCCUPANCY 1 NO. MOWELUNUUNIT5 <br />GROUP <br />G� <br />BASEMENT <br />❑ YES NO <br />PLUMBING <br />MECHANICAL <br />' <br />' <br />I <br />ADDITIONAL PLAN CHECK <br />; <br />' <br />OCCUPANCY LOAD FIRE ALARM REO'0 HEIGHT LIMITATION <br />Q 1,10 <br />RE—ASON--- <br />OTHER <br />STATE BUILDING SURCHARGE <br />' �"- <br />' G <br />PUBLIC WORKS <br />' <br />INTAKE BY <br />? VED BY <br />'1YI,•1 <br />EDATEI / <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/�-� <br />3d i(/v <br />