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APPLICATIC 1 FOR CONSTRUCT 7N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: Q{ GAS 0 ELECTRIC ❑ _ <br />259-8810 <br />i I DEMOLITION ❑ COMBINATION ❑ BUILDING t,MECHANICAL CIPLUMBING ❑ SIGN <br />O EP MAC ADMES$ cm ZIP PHONE <br />/ ,j �rYVPSi-YAY 'i- �(ba ty"', g /t!6 - a� "OJ 4)e 914 5t°GILgp '?L&:. <br />TENANT I MACAMFIESS cm ZIP PHONE <br />ANCMRECTOPDESIGNER MAC ADDRESS Cm ZIP PHONE <br />CONTPACTPPICEOFWORf Q <br />�"InT OFI <br />DIXN�/ <br />bh Oh v <br />1 <br />DE$cPRE YroRK AND SQUARE F ADE p1Y0.VE0 <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />9 /17,11 <br />PP Du of Puuomo 1 <br />T <br />LEGAL DESORIPTICHOF PROPERIYISHOAN MEOW ON ATTACH TW COPIESI <br />tot BLOCKDF <br />PARCEL TAX I D. NUMBER <br />CCA$TRUCTICH LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS �/,/ <br />1r2a t[, £��E�{.Q///�j (Q <br />s.IAI.E <br />ary eusHrsslcwuw <br />PLUMBING 4' <br />MECHANICAL <br />110. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIFMENT <br />FEE <br />WATER CLOSET (TOILET) <br />Nr AIHNOLG UNITS—H.P. <br />BATHTUB <br />FORCEDAIRSYSTEMS—B.TU. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL f <br />_ <br />PERMIT <br />f <br />PERMIT f <br />_ <br />TOTAL FEE <br />$1 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETB.ACF <br />REARSETBACK <br />SIDE SEIBACK <br />PUW CHEGIt /MP <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />UK OF CWST <br />NO OF STORIES <br />OCMULI IBawnu�cuNn <br />SQEOFBLDO <br />FIRESPRWKLERSREOD <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />-ADDITIONAL PUN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED 0 <br />HEMNT LA,B <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />MTAKE BY <br />P.AN$APP OBY <br />1hNq <br />WIE ;� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAR COOS IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />