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APPLICATIC-A FOR CONSTRUCT -:-ON PERMIT e <br />� TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: IDGAS ❑ ELECTRIC El <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL PLUMBING ❑ SIGN <br />OWNER I MAIL ADDRESS �CITY ZIP PHONE It�O ilYti� �PnTS'L F-tyrPtL LA110 • _zoI otDb-254- oc4Ly _- <br />TENANT MAIL ADDRESS CITY/ ZIP PHONE <br />N pv�1 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRY ZIP PHONE <br />�-r�c2C1��1n <br />�NERA((L��CONTR1Ann'CTOR MAIL ADDR'F[S\'G�/ CITY `C Zip PHONE PHONE STATE LICENSED <br />tOC `t�Vr��C ��\J LC"� C>�\�T, ltl�+-✓T�\�7�VCVVe1 <br />MECHAN IOAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSED <br />�P MBINGCONTRACTO _ MAIL ADDRESS CITY ZIP PHONE STATE LICENSES <br />\1AY,, �n L1�ctF_��gL)I W%_' 4�_1'2DI <br />CONTRAJI PRIC�qF WORK f j <br />DE'CJ RIBF a WORK AND SQUARE F=AGE IN OLVED <br />CON T PERSO NO Pr�ONE N <br />�. t�1Vt(1/Y`% <br />�.awhMir2c \Yll i�C� (n �� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />ALL <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC'. <br />0 <br />PC(R 71ED USE O-BUILDING. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�� VMSE <br />r.eC <br />WORK WILL BE COMPLE'i ED WITH WHETHER SPECIFIED HEREIN OR <br />OR A7TACH'I'NO COPIES) <br />LEGAL DESCRIPTICN OF PROPERTYISHOWN BELOW <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />n (C �- <br />LOT hY BLOCK OF T <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 AIA AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C014T/R�ACTORS /LAW 18.27 RCW AND 296.220001WAG. <br />PARCEL TAX 1.0. NUMSER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />SONA/ATUR'E ATE <br />PRO, <br />ADDRES <br />Crtv RJS'NESS <br />LICENSE NO <br />,// <br />'�J <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. <br />_ <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />, <br />NC-A/HNDLG UNITS-H.P. <br />' <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />, <br />UNIT HEATERS-B.T.U. M <br />' <br />' <br />' <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />F <br />LAUNDRYTRAY <br />WATER HEATER <br />- <br />— <br />- <br />CLOTHES WASHER <br />URINAL <br />, <br />, <br />' <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />' -- <br />' <br />' <br />DRINKING FOUNTAIN <br />' <br />, <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />' <br />' <br />GAS PIPING <br />) <br />' <br />ROOF DRAINS-RAIIJLEADERS <br />EXHAUSTFAN <br />, <br />SINK (SERVICE -BAR, ETC.) <br />I <br />' <br />SUBTOTAL $ <br />, <br />;- <br />SUBTOTAL S <br />— <br />PERMIT $ <br />2 GY ' <br />PERMIT $ <br />— <br />-- _ TOTAL FEE $ <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICE USE <br />ONLY: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECKNUMBER <br />FRONTS BACK <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />YES ❑ NO <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />TYPEOFCONST. <br />NO, OF STORIES <br />=uP <br />GRGuv <br />NO V DMLLINS UNGS <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARMREO'D <br />HEIGHTLIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLICWORKS <br />REASON <br />INTAKE By <br />PLANS APPROVED BV <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />FEE <br />VALID <br />m <br />10 <br />