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APPLICATIO'"` FOR CONSTRUCTI'�'N PERMIT � <br />1 TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />�� HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �Q SIGN <br />OWNEfl MFILAD�RESS CITV pZIP PHONE <br />�;��L'.1./.ol.�rnJ/sn0 F.ua�t,o�.�w�.c4��..'�.t� 9�'io3 7�o-GsolJ <br />TENANT MAIL RDDRESS CITY ZIP PHONE <br />��I /i .ii �LN _/_'"..A�__�G//�""—�l <br />��ry ZIP PHONE <br />GENERA CONTflACTOR MAILAOORESS CIN ZIP PHONE STATELICENSEN <br />CITY <br />w�.�v.d:..�� <br />ONTRACTOR MFIIA �RE55 <br />� <br />PRIGE OF WOlFK <br />� . /R/L/ <br />IOPK ANU SOUARE FOOTAGE INVOLVED <br />� <br />�:. <br />'/ ✓ <br />USE OF BUiLDING <br />LEGAL UESCRIPTION OF PROPERTV (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXI.D.NUMBEfl <br />���pgo� 3-ott� -Do�7`f <br />CONSTRUCTION LOAN LENUER. ADORE55. TELEPHONE NUMBER <br />Pp W ECT ADDRESS <br />� �� SE ir.�ert���nZf.�i'lI/kl -�o� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP _ <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEfiS <br />ROOF DRAINS-RAINLEADERS <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REARSEiBACK I <br />USEZONE TAREA <br />C- � `�'S`� <br />TYPEOFCONST. NO.OFSTORIES <br />SIZE OF BL�G. <br />OCCUPANCVIOAD <br />REASON <br />INTAKE BY <br />FIFE SPRINKLERS REO'D <br />FIRE ALARM REO'D <br />PLANSAPPROVEDBY <br />OFTE `�M/r�%� <br />SETBACK <br />VACANT SIiE <br />❑ YES ❑ NO <br />OCLUPANLY NOOiDWfL11NG11Yii5 <br />GNOUP <br />❑ YES ❑ NO <br />HEIGHi LIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />ZIP �`=E <br />7.1? <br />CONTACT PERSON AMD PHONE NO. <br />p <br />STATE LiCENSE N <br />I HEREBY CERT�FY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AL.L <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 AEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHQRIZED BY THE <br />OWNER OF THIS PFOPERTY TO PFRFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I�COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x i�s� a %�lc.�-"c� 2 -� -9 �f <br />5� FIDRE OQE <br />MECHANICAL <br />10. TVPE OF E�UIPM <br />-TA/C-A/HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIflEPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAI <br />S <br />S <br />PLANCHEC NUMBEF ree <br />/ �J /� 7/� _ Qh � <br />BUILDING �J`t 1 <br />PLUMBING � <br />MECHANICAL 1 <br />�-- � <br />A�DITIONAL PLAN CHECK � <br />i <br />OTHER � <br />— <br />STATE BUILDING SURCHARGE <br />i <br />PUBLIC WORKS � <br />` � <br />TOTAL _') � � <br />