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APPLICATI" FOR CONSTRUCT --IN PERMIT <br />f It TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ('GAS ❑ ELECTRIC ❑ <br />259-8810 <br />El DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ElPLUMMMBING ❑ SIGN <br />nwuvR MAILADDRESS CITY ZIP,T �� PHONE 7�� <br />TENANT MAUL ADORES y�� CII/TYY ZIP yP.HHOONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY IP PHONE <br />GENERf1 CONTRACTOR MAIL ADDRESS CRY ZIP PHONE STATE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE Sj�TELLCENSEJI� `tea Q G <br />,.i-�-T� t"` rrt-�i O <br />PLUMBING CONTRACTOR MAILADDRESS CRV ZIP PHONE STATE LICENSE 1 <br />CONTRACT PRICE OF WORK <br />a <br />DESCRIBE WORK AND SOUARE DOTAGE INVOLVED <br />CONTACT PERSON AND <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORKWILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OFPROPERTY ISHOWNBELOWOR ATT�TWOSI <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT- BLOCK OF <br />AUTHORITY TO VIOLA) c 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 SHE <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 />PARCEL TAX 1 D. NUMBER <br />CONSTRUCTIONLOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />'"D.-E <br />CITY BUSINESELICENSEH - <br />ll— <br />PLUMBING <br />MECHANICAL <br />_ <br />N0. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNOLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEFT !'UMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />` <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />-- <br />T <br />i <br />i <br />SUB TOTAL S <br />' <br />SUB TOTAL $ff <br />' <br />PERMIT $ <br />PERMIT $ <br />ITOTAL <br />FEE S <br />TOTAL FEE' <br />FOR OFFICE USE ONLY: <br />CDnMT iPTRCCK REAR SETBACK SIDE SETBACK <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />BUILDING <br />' <br />1YPEOFCONST. <br />NOST .OF-C <br />GM;PANG� <br />NG. GFDWFLURG UNnG <br />' <br />GRWP <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />1 TOTAL <br />I DATP <br />