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APPLICATIC_1 FOR CONSTRUCT71IN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: j GAS ❑ E_ECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION F I BUILDING !(,MECHANICAL tI�PLUMBING SIGN <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 LICENSE# <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE # <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />'HONE <br />STATE LICENSE # <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <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 LAWO 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 CONS) RUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <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 />!7,# <br />rTE�_ <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT- BLOCK -- OF <br />PARCEL TAX I.O. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJE�OTTADDRESS <br />G <br />'� BE Q <br />CVyI3USNESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C -A HNDLG 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 />; <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE -BAR. ETC.) <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FnN nFFIrF LISF nNLv- Lj( / 15? Q' 1 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />FLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />EES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />❑ YES ❑ NO <br />jRPE DF CONSL <br />/ <br />NO, OF STORIES <br />#CCUwxm <br />GUo p <br />No. OF VHELUNG UNITS <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RECID <br />BASEMENT <br />MECHANICAL <br />YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />I <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BV <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />