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APPLICATIGd FOR CTONSTRUCT iON PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />GATING SYSTEM: ❑ GAS J ELECTRIC J __ <br />BUILDING DEPARTMENT <br />259.8810 <br />DEMOLITION i 1 COMBINATION BUILDING MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAILADORESS CITY ZIP PHONE <br />�oE6Gin / Scsv — <br />TENANT lAAIL ADDRESS CRY ZIP PHONE <br />ARCHITECT ORD SIGNER MAIL ADDRESS CITY 0 ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />s,Am ucervce• <br />-4cc <br />3C)!yaZdA,4(. <br />i sf 12ppga-n <br />(4 9f//)Ca 3 <br />`/1S36i/77d <br />GJ.L.IS Y�f rOrQ� <br />MECHANICALCONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE IT <br />lug <br />I <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CRY <br />ZIP <br />PHONE <br />CLASS OF WORK <br />{ ❑ NEW ❑ ADDITION 1. 1 ALTERATION I REPAIR 1_1 DEMOLITION ❑ WOODSTOVEIFRPL INSERT I I BUILDING RELOCATION <br />E3FC, <br />d <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <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 18.27 RCW AND 296.200 WAC. <br />Iyk ' <br />ry r s <br />x <br />PROJ,EC/TADDIES5 /^/n/ // 11 <br />-5)� GE% / la// ✓- <br />BICNAtuAE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBIMG <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 />A/C—AfHNDLG UNITS—H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />, <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />' <br />HEATPUMP <br />' <br />BACKFLOW PREVENTERS <br />1 <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />i <br />I <br />, <br />I <br />' <br />SUB TOTAL <br />$ <br />i <br />SUB TOTAL $ <br />PERMIT <br />$1 <br />PERMIT $ <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />' <br />wr E,PL' ^LII V. <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />*3sa0-5 <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />' <br />i <br />TYPE OF CONTE. AL <br />TYPE CONST. ACTUAL <br />OttuWXq <br />cawv <br />NO.OFMILINGUXITS <br />SIZE OF SLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />SPRINKLER <br />� <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY PUNSAPPROVEDBY CITY OF EVERETT <br />LOCAL SALES <br />TAX. CODE IS 3105 <br />TOTAL <br />4 <br />