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APPLICATICI FOR CONSTRUCT -IN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUII.DING DEPARTMENT HEATING SYSTEM: ' GAS U ELECTRIC 0 _� <br />259-8810 <br />DEMOLITION CI COMBINATION BUILDING >CMECHANICAL 1 1 PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />`i/ ,N/ �J7�i r�/h/S il(r30 alb /4!/ GyT• �%_g2/ L$$-3'L%/ <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />MAIL ADDRESS CITY ZIP PHONE STATE LICENSE a <br />CITY ZI- PHONE STATE LICENSE e <br />CONI RACT 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 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 CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION 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 ADE AND I COMPLY WITH THE STATE <br />CONTRACT SLAW 6.27 RCW AND 296.200 WAC. <br />X L% \ _ <br />PROPOSED USE OF BUILDINpG <br />: e/ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS •, <br />O G Iv <br />- <br />sluNAro+t�� <br />CITY BUSINCSSp CNSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUI^MENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P. <br />BATHTUB <br />; <br />/ <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />T <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />i <br />VENTILATION FAN <br />'-- <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />_ <br />BACKFLCW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />_ <br />SINK (SERVICE -BAR. ETC.) <br />- <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />cno nccicc I Lcc nUl V- <br />FRONT SETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHECK I4UMB/ER <br />ILII <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />--- <br />--- <br />TYPE OF CONS), <br />NO OF STORIES <br />BaimrY <br />110 VMILING WtS <br />I <br />cemre <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />MECHANICAL <br />I <br />' <br />❑ YES G NO <br />- <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE ALARM RED D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />——?— <br />STATE BUILDING SURCHARGE <br />INTAKEBY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />