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APPLICATIOM FOR CONSTRUCTO`N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 4:7'r <br />HEATING SYSTEM: J GAS <br />J ELECTRIC J _ _ <br />_ 1 <br />BUILDING DEPARTMENT <br />259-8810 <br />Il DEMOLITION LI COMBINATION <br />❑ BUILDING <br />MECHANICAL PLUMBING <br />SIGN <br />OWN/R MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />—EJ-N--:- <br />MAIL AD RESS <br />`ITV <br />21P FHONE <br />T ANT1—� <br />l <br />4 <br />ZIP PHONE <br />CITY ZIP PHONE STATE LICENSE X <br />GE ERAL CONTRACTOR` <br />MAIL DDRESS <br />1 <br />ZIP PIIONE STATE LICENSE A <br />MECHANICAL CONTRACTOR <br />I7 <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSE s <br />PLUMBING CONTRACTOR <br />�? <br />MAIL ADDRESS <br />CITY <br />CONTRA PRICEOFWORK <br />DESCRIBE WORK AND SQUARE FOUlAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />I <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />p SED USE OF BUILDI G� <br />• �..(�C[ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�� <br />" <br />L L BE COMPLETED WITH WHETHER SPECIFIED E REIN IV <br />LEGAL DE IVTION OF PROPERTY (SHOWN BE OW OR ATTA r. COPIES( <br />DOES NOT TO GIVE <br />NOT THE GRANTING OF A PERMIT PRESUME <br />OF <br />AUTHORITY TO VIOLATE CANCEL THE PROVISIONS OF ANY <br />Lor n � <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />BY THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED <br />OWNER OF THIS OPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION 17MADE AND I COMPLY WITH THE STATE <br />CONTRACTO 18.27 RCW AND 296.200 WAC. <br />PARCEL TA%LU. NUMBER <br />CONSTRUCTIOII LOAN LLNDER, ADDRESS, TELEPHONE NUMBER <br />ar �_ <br />DATE <br />TxAiU <br />PROJECT ADDRESS <br />crtr rus N' St No <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO, TYPE OF FIXTURE OR ITEM <br />AIC—A+HNDLG UNITS—H.P. <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS—B.T.U. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS _ <br />VENTILATION FAN <br />KITCHEN SINK A DISP <br />RANGE HOOD <br />DISHWASHER <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />WOOD STOVE <br />' <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />FIREPLACE INSERT <br />— <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />- <br />BACKFLOW PREVENTERS <br />- <br />EXHAUSTFAN <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR. ETC.) <br />--- <br />SUB TOTAL $ <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />&o <br />FOR OFFICE USE <br />ONLY: <br />_ <br />PLAN CHECKwm <br />FEE <br />RECEIP NO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />' <br />A^ <br />(7/FEES <br />C> <br />T <br />l,� <br />J_ <br />VALUATION <br />FEE <br />USE ZONE <br />LOT AREA <br />o"v 7 4?50 0 <br />VACANT SITE <br />❑ YES %'NO <br />BUILDING <br />_ <br />TYPF OF CONSi <br />IE OF ST <br />ORIES Opg <br />� OR CS <br />ottm•Axcr NO a Wrttuxc uluA <br />c WV / <br />PLUMBING <br />—_ <br />SIZE OF <br />FIRE SPRINK: ERE REO'D <br />BASEMENT <br />MECHANICAL <br />l S y.1�'1 <br />`lJ <br />AJb <br />❑ YES ;C O <br />ADDITIONAL PLAN CHECK <br />,{I <br />OCCUPANCY LOAD <br />FIRE AV FV REO'D <br />AJp <br />HEIGHT LIMITATION <br />_ <br />OTHER <br />REASON <br />STALE BUILDING SURCHARGE <br />L 9 <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETi <br />PUBLIC WORKS <br />+ <br />fh <br />LOCAL SALES <br />u <br />TAX CODE IS 3105 <br />TOTAL <br />