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APPLICATIC^ ] FOR CONSTRUCT" 1I� P�I�MIT � <br />TO BE COMPLETED IN HLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ � <br />259-8810 <br />❑ GEINOUTION ❑ COMBINATION U BUILDING L7 MECHANICAL ❑ PLUMBING ❑ SIGN <br />01YNER MRILADDRESS CITY ZIP PHONE <br />[�uQeN Offam��2 s�� -�t5 �sea. wa �r � c� 0 7 7R -! �o / <br />TENANi MAILADOFL55 CIiY ZIP PHONE <br />ARCHITECTORDESIGNER MAILAODRE55 CITY ZIP PHONE <br />C-�4P/Yse mN.s. �N�. Pos« ses wcna��de w4• -�iSSo7Z ZoG-788-37zp �c ze7K� <br />GENERALCONTRACTOR MAILADDRE55 CITY ZIP PHONE STATELICENSEN <br />MECMANICALCONTRACTOR MAILADURESS CITV ZIP <br />PLUNBING CONTPACTOP MAIL AOOFE55 <br />CONTRACT PflILE OF WOf.K <br />DESCRIBE WORN <br />OF BUILDING <br />LEGAL DESCFiIPTbN OF PROF'cfliV �SHOWN BELOW OR ATTACH TWO COPIES� <br />LOT BLOCK OF <br />Su�ca•J!, 3t �oFS <br />PAFCELTAXID.NUMBER <br />loaSos- 3- o/e•ooi <br />CONJTRLICTION IOAY LENDER. AUDPESS, iELEPHONE NUMBER <br />PROJECT <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILETI <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FGUNTAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.1 <br />SUB TOTAL $ <br />FOR OFFICE USE ONLY: <br />FqONiSETBACK REARSETBACK <br />USEZONE LOTAREA <br />lYPEOFCONST N(1 OFSTORIES <br />SRE OF BLDG. i FIRE Sr'FINKLERS RE�'D <br />1'IRE ALAFM dE0'� <br />REASON <br />�Y I 7LANSPPPROVEDBV <br />OATE <br />C7Y 21P <br />CONTACT PERSON AND PHONE NO. <br />FHONE STATELICENSE;I <br />LICENSE a <br />i HEREBY CERTIFY THAT I HPVE READ AND EXAMINED THIS <br />APPLICATION AND KNUW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL EE (;OMPLETED WITFi WHETHER SPECIFIED HEREIN OR <br />NOT. THE GR4N; ING OF A PERMIT DOES NOT PRESUME TO 31VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATF: OF LOCAL LAW REGULATING CONSTRUCTION OF THE <br />PEiIFORMANCE CF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TIiIS PROPERTY TO PERFORM THE WORK FOR WHICfi <br />APPLICATION IS MADE AND I COMPLY VJITH THE STATE <br />CONTRACTOFS LAW 1827 RCW AND 296.200 WAC. <br />SiGNAiUPEU.L� �, <br />�itl/Q � CiiTBU51NE55lICE��5EN0 <br />� MECHANICAL <br />FEE NO. TYPE O <br />SIOE SETBACK <br />VACANT SITE <br />❑ YES ❑ IJO <br />OlL11VANCY HOAfOWEllIY6UNIiS <br />LNOUP <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />1=0RCEU AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACE INSERT <br />EXHAUSTFAN <br />/ <br />eui�oiNc <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CFECK <br />OTHER <br />STA7E BUILDING SURCHARGE <br />PUBI.IC WORKS <br />TOTAL <br />F1� <br />SUB TOTAL $ ' <br />PERMIT $ <br />TOTAL FEE $ � <br />RECEIPT NO. <br />VALUATION FEE <br />'�'�Tl� O � 7t7 <br />1 <br />i <br />� <br />i <br />i <br />j !�'�> <br />I <br />� <br />i <br />