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APPLICATIC . FOR CONSTRUCT, )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ElELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION IJ COMBINATION BUILDING ❑ MECHANICAL C PLUMBING ❑ SIGN <br />,........ .....e�oc� CITY VP PHONE <br />TENANT A. <br />ARCHRECTORDESKNER MALAODRESS CITY ZIP PHONE <br />pLUABMGCdRMCT(NH MAL ADDRESS CITY ZIP PHONE BTATE LICENSE[ <br />CDNTRACTPRICECI IHN 'vV <br />DESCRIBE NOAKKNI SQUARE FOOTAGE <br />CONTACT FERSON AND PHxE CNO 33 <br />Il <br />�YO Z <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 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 EY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�18.27 RC AND WAC, <br />CONTRACTORS LAW W <br />w Tf--����� <br />AKJM ozj b ar[ <br />nn eusixFn f.FxS[ <br />PRDPDSEOUSE oP eunowc <br />LEGX DEXIEPTION OF PROPERTY (SHO1 ULM OR ATTACH TND COPIES) <br />UOi BLOCrc DE <br />PARCELTAK 0NUMBER <br />CONSTRUCTA%LOAN LENDER. AESS DDR.TELEPHGIENUMBER <br />PODflE S <br />WiZ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. I <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK S DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGEHOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE LISE ONI V. <br />FRONT SETBACK <br />PEMI SETBACK <br />SxR SETBACK <br />PIANCHECKNUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />MET MIEA <br />VACNMT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />rc3 <br />IYPf Of CDxST. <br />NO.OP B}DIIIES <br />arnAAAn KoawTUKNuIUL <br />FADS <br />PLUMBING <br />I <br />MOFBLD6 <br />FIRE SPRMKLEBS nEO➢ <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPMA:YLMO <br />FIRE MARM REOD <br />NEIBW MUTATION <br />OTHER <br />RFABON <br />STATE BUILDING SURCHARGE <br />wtu:ERr <br />PUNS APPROYEUBr <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />