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A�APLICATICy1 FOR CONSTRUCT"1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT �HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />iJ DEMOLITION ❑ COMBINATION �J BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER �AqILq��RE55 SU7 f-�¢ CITY ZIP PHONE <br />n... � _ .. ._ __ _ _ _ <br />TENANT MAILADDRE55 LITY ZIP PHONE <br />U.�G,G�J T <br />ARCHITEGTORUESIGNER lAFILADDRESS qTY ZIP P40NE <br />�J'P/�31.�-2 <br />GENEf1AL CONTRACTOR MFIL ADDRE55 CITY ZIP PF:ONE STATE LICENSE a <br />MECHFNICALCONTRACTOR MAILAD�RE55 CRY ZIP PHONE STATELICENSEa <br />PLUTABINGCONTRFCTOq M�ILAODRESS <br />CONTR4CT PRICE OF WORK <br />��� m <br />]ESCFI6E WORN �ND SOUAFE FOOTAGE INVOLVED <br />F-�' �7%/ <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPiION OF PROPERTY (SMOWN 6ELOW OR ATT�CH TWO COVIES� <br />LOT BLOCK OF <br />PARCELT�XI.�.NIIMBER <br />CONSTRUCTIONLOANLENDER,ADDRESS.TELEPHONENUMBER <br />� <br />NO. I TYPE OF <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />DISH WASHER <br />CLOTHES WASHCR <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK ISERVICE—BAR. ET( <br />SUB TOTAL 3 <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FPONTSETB�CK REARt <br />iYPEOFCONSi <br />�� <br />52E OF �LDG. <br />i117b�IF I��• <br />OCCUPANCVLOFD <br />y�G <br />REASON <br />INTAKE (3Y <br />LOT AREA <br />FIRE SPRINKLERS REO'D <br />�V <br />FIflE ALARM REO'D <br />ND <br />PLANS <br />onre <br />SIDE SETBACK <br />CITV ZIP <br />C� NTACT PERSON AND PHONE N0. <br />STATE LICENSE p <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 'iHIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI? DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOFAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br />�x�e.��'�.� .�►�-5� %-�9"�� <br />� sicaiuWE oatE <br />CIiY0U51NE55lICENS[ NO. <br />FEE NO. TYPE OF EOUIPMENT FEE <br />� A/C—A/HNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT HE�\TERS—B.T.U. M ; <br />' CLOTHES DRYERS <br />� VENTILATION FAN � <br />T <br />� RANGEHOOD , <br />; WATER HEATER � <br />� WOODSTOVE ; <br />; METAL FIREPLACE (WOOD BURNING) <br />� FIREPLACE INSERT ' <br />� HEAT PUMP � <br />� GAS PIPIWG � <br />! EXHAUSTFAN ; <br />❑ YES ❑ NO <br />:OPA!ICY NOOiONRL�160Vi15 <br />❑ YES �v NO <br />HEIGHi UMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />O�� I FEE I RECEIPTNO. <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />A�DITIONAL PLAN CHECK <br />OTHER <br />STATE �111LDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />i <br />i <br />i <br />i <br />� <br />