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APPLICATIQ"�� FOR CONSTRUCT' )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />B 43�33 <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ � <br />zss-aai o 3� 7- 50/3 <br />❑ DEMOLITION ❑ COMBINATION C BUILDING ❑ MECHANICAL ��PLtJMBING ❑ SIGN <br />OWNER MAILADORESS CITY <br />r .�,v�lar�csror..� c,��rr v���6N ti �� <br />TENANT MAILPDDRESS �� CITV <br />1� I� <br />PRCHITECTORDESIGNER MAILAOOAESS CI�V <br />GENEflALCONTflACTOR MAIf,pPDRE55 �CITY <br />dECHrWICALCONTflRGTOR MAILPUDRESS <br />'LUMBINGCONTRACTOR MAILADDRESS <br />Kl���.�fb,� I�c.vvt4lo.�T <br />CONTflACT PRICE OF WORK U <br />�r��o = <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />LEGAL DESCRIPTION OF PflOPERTV (SHOYJN DELOW OP Ai7ACH iW0 COPIES) <br />LOT 9LOCK OF <br />PARCELTA%I.D.NUMBER <br />CONSTRl1CTION IOAN LENDER. <br />TYPE OF FIXTURE � <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHFR <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />]NENUMBER <br />�/G-G <br />ITEM <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE c�NLY: <br />FRONTSETBACK FEARSETBACK <br />USEZONE LOTAREA <br />TVPE Of CONSi. NO.OF STORIES <br />SIZEOFBLOG. FIflESPRINKLERSREO'� <br />OCGUPANCY LOAD FIRE ALARM REO'D <br />REASON <br />INTAKEBV PLANSAPPROVED <br />DnTE <br />CITV <br />I�p PMONE <br />SLS G�� l/!/l�/dLL ��%� L� <br />21P ^ PHO� <br />�1 t � •� <br />� l <br />ZIP PHONE <br />ZIP PHONE STATE LICENSE M <br />! �oti�'�SOD <br />�I�p PHONE STATELICENSEM <br />ZIP PHONE STFTELICENSEx <br />� 7�-6�/5 <br />X��C�POI�CD�i`t (�Q <br />g � c -641s <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 PERDAIT 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 />PERFOf;MANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I C MPLY WITH THE STATE <br />CONTRACTORS LAW 827 RCW AND 2 200 WAC. <br />�/l///�_..nIIJ / �///�/�� <br />NO. TYPEOFE�UIPMENT FEE <br />A/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 HEATEfl <br />WOOD STOVE _ <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETBACK PIAN CHE N NUMBER FEE <br />35� <br />VACANT SRE FEES <br />❑ YES ❑ �0 BUILDING <br />acuanxcv xo.ovow[uixeu�urts <br />enour PLUMBING <br />BaSEMEN7 MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMITATION ADDI710NAL PLAN CHECK — <br />OTHER <br />S7ATE BWL�ING SURCHARGE <br />CITY OF EVERETT PUBLIG WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />S <br />i <br />i <br />i <br />H <br />