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r3�- 3ti�, <br /> APPLICATIQ�� FOR CONSTRUCT�N PERNfI� � <br /> 70 BE COMPLETED IN BLACK INK-PIEASE PRINT <br /> HEATING SYSTEM: 67 GAS O ELECTRIC � <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION �-'BUILDING Ci MECHANICAL ❑PLUMBING ❑ SIGN <br /> MML A�DRE55 CITV ZIP PHONE <br /> OW'1ER r. <br /> C y �.�,�-se v-�- � � ss Z �a <br /> TENRNT <br /> MAILADDPE55 CITY ZIP PNONE <br /> ��T, Z�p PHONE <br /> pRGHITECTORDE5IGNER M�ILADDRESS <br /> GE�NEN`QCONTPALTOR MAILADDRE55 <br /> CITV ZIP PNONE SIATEUCENSEa <br /> ly � /�t�! �y0 �� .S �b`o'�� <br /> ��T, Z�p PHONE STATELIGENSE� <br /> MECH/UIICALCON7MCTOR IM�LADDPESS <br /> ��T, Z�p �MONE ST�TELICENSE� <br /> PLUMBINGCOMTRRCTOfi M�ILADDRESS <br /> ppMiAABT PRIGE OF WORK � w1 <br /> �pN7� p$ON AND PHONE Nf�j , a L(��O <br /> ' DESCRIBE WORN AND SOUARE FOOTAGE INVOlVEO j�O `- , <br /> � � � I HEREEY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TQ BE TRUE AND CORRECT.ALl <br />' � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�LOESCHIPTIONOFPROPERTYISNOWNBELOWOPATTACMTWOCOPIES) NOT. THELGRANT�NG OF A ERMITyDO SENOT PR'ESUME TO GI�VE <br />'. �aT eiwK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEFiFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ' qPPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEI T�%1.0.NUMBEX CONTR ORS LAW 1827 RCW AND 296200 WAC. <br /> S` ) (i$'— 531- 001 — OZO� � <br /> CONSiRUCTION�OANLENDER.l1DDNE5S.�LEPHONENUMBER � .L � <br /> SqN�TU O.TE�'!I� <br /> vnaecr�ooness .t y Z G <br /> crt messucEr�sE�+o <br /> ��'� CHANIC�L <br /> FEE Np. TYPE OF E�UIPMENT �E <br /> Np, T/pE OF flXTURE OR ITEM ,q�C—q�HNDLG UNITS—H.P. ' <br /> WATER CLOSET(TOILET) ' � <br /> � � FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> BATHTUB ' � <br /> � LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHES DHYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN �— <br /> DISHWASHER � RANQE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> � CLOTHES WASHER � WOOD STOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> � URINAL � FIREPLACE INSERT � ' <br /> � DRINKING FWN7AIN � HEAT PUMP � <br /> j ����'� . � . , FLOORDRAM � GASPIPING ' . <br /> BACKFLOW PREVENTERS � EXHAUSTFAN <br /> f a�� I ROOF DRAINS—RAINLEADERS ' � <br /> ' i SINK(SERVICE—BAR,ETC.) � ; � <br />� 1 <br /> ���' � <br /> � <br />� ��� , SUBTOTAL S � <br /> � � SUB TOTAL S � ' <br />, � PERMIT 5 PERMIT 5 ' <br />� `?-;; TOTAL FEE S ' <br /> TOTAL FEE S <br /> j <br /> ;+.�t;�., j FOR OFFlCE USE ONLY: FEE RECEIPT NO. <br /> � � REAR SETBpCK SIDE SETBACN P��N CMECK UMB F <br /> �f��,-' � FRONT SETBACK <br /> e:�-5'-� ' VALUI1T10N FEE <br /> �•� . USE ZONE LOT AR[A VACANT SITE FEES �� ' �� <br /> ���. ❑ YES � N� BUILDING � <br /> -` " NO.OFSTORIES Ouuor.xtr xoorowFuiNcuvns � <br /> ; ;r. � TYPEOFCON57 ;nouv PWMBING � <br /> i <br /> o:., i <br /> � - 52E OF BIDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL i <br /> p . . G YES ❑ NO � <br /> �1 HF.IGHT LIMITATION ADDITIONAL PLAN CHECK <br /> FIRE AIARM REO'D � <br /> „'. OCCUPANCVlOAO � <br /> � OTHER �Q, <br /> . REASON STATE BUILDING SURCHARGE ' '+— <br /> � INTAKE BY PUNS APPROVED B� CITY OF EVERETT PUBLIC WORKS ��� <br /> LOCAL SALES ! <br /> D�TE <br /> TAX CODE IS 3105 �TAL J � <br />