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APPLICATIO" FOR CONSTRUCTInN PERMIT <br />TO BE COMPLETED IN BLJICK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J <br />259-8810 <br />DEMOLITION COMBINATION BUILUING ECHANICAL PLUMBING SIGN <br />DIN I MgILADDRESS CITY ZIP PHONE <br />c*+7 1' L)ama <br />an mod o <br />j R�A <br />C <br />lYEr <br />TENANT <br />All Oa <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSES <br />MECHANICAL CONTRACT F <br />N.w,RACTOR -�Ea�cr <br />PLUMBING CONTRACTOR <br />MAIL DDRE55 <br />U06, MAW <br />MAIL ADDRESS <br />CITY <br />W <br />CITY <br />• S��t��►I <br />ZIP <br />ZIP <br />PHONE <br />z�i <br />PHONE <br />STATE LILENSEq <br />� -M�io3e� <br />STATE LICENSE, <br />CONTRACT PRICE OR <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTAC ERSON A N0.�� �' �' <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 CA ' EL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW GU TING CONSTRUCTION OR THE <br />PERFORMANCE OF T TION THAT I A AUTHORIZED BY THE <br />OWNER IS PROP Y TO P RFOR E WORK FOR WHICH <br />APrL IS MA AND I C WITH THE STATE <br />CO S LAW 18 % RCW D .2 WAC. <br />PROPOSED L'SE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES( <br />LOT BLOCK of -' <br />PARCEL TAX LD. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS�nog o _)_e � <br />(J L <br />oAte <br />CITYBSIGNATu <br />arr e uswc sI eNsem <br />PLUMBING <br />MECHAj4j9AL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—A HNDLG UNITS—H.P. <br />, <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />, <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />1 <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />; <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />1 <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />, <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />, <br />1 <br />T <br />1 <br />1 <br />1 <br />1 <br />� <br />SUB TOTAL $ <br />SUB TOTAL $ <br />i <br />_ <br />PERMIT $ <br />1 <br />PERMIT $ <br />TOTAL FEE S. <br />' <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />gg7o <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />i <br />TYPE OF CONST <br />NO. OF STORIES <br />GCcNPANCv <br />NO OP OAEUING UNITS <br />GITOUP <br />PLUMBING <br />1 <br />1 <br />, <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />C YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />OTHER <br />1 <br />_ <br />REASON <br />STATE BUILD:NG SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />i <br />