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APPLICATIC 'I FOR CONSTRUCT' 1N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT <br />259 <br />HEATING SYSTEM: ❑ GAS ]ELECTRIC ] -- <br />-8810 <br />❑ DEMOLITION <br />❑ COMBINATION <br />❑ BUILDING <br />❑/ <br />PLUMBING <br />OWN <br />ADDRESS <br />> <br />CITY <br />Z17 NE <br />L 1 SIGN <br />— <br />a <br />/MCE�CHAXNIIICOAL <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />f�ENl�I <br />7��r <br />16SdI.� 1k)6;; <br />=l�r <br />A CHI�i TECT pq DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />r-7, <br />k ( IR <br />�`,,� ) <br />GENERAL CONTRACTOR <br />MAIL AODREBS <br />CITY <br />ZIP PHONE <br />t <br />STATE LICENSE 8 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE A <br />SC <br />a1� I ; <br />�� t��.L& <br />�I H r <br />9�g- s <br />CONTRACT PRICE OF WCt( <br />. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />�p <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE ' ID CORRECT. ALL <br />NANCES <br />LAWS ANDTYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />WORKS WILLSBEFCOMPLETED WIITIH WHET ERVERNIS ECIIFIEDHIS HEREIN OR <br />LOT BLOCK OF <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 IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TAX I.D. NUMBER <br />CONTRACT R 18.21 RCW AND 296.200 WAG <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />A-L <br />PROJECT ADDRESS <br />s. oArE - <br />.N 1S <br />cnv RuslNLss LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER _ <br />' <br />CLOTHES DRYERS <br />r— <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRI'TRAY <br />WATER HEATER <br />)- <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />' <br />FIREPLACE INSERT <br />HEAT PUMP <br />EG R DRAIN <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />.20 <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />PEAR SETBACK <br />SIDESETBACK <br />PLANCHE5KNUMBER <br />FEE <br />RECEIPT NO <br />SL LY/ <br />uSE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />CI YES ❑ NO <br />BUILDING <br />' <br />TYPE OF CONST. <br />NO OF STORIES <br />OCCORANCY <br />NO OFONTtt INGUNITS <br />PLUMBING <br />i <br />I <br />ORNP <br />SIZE OF BLDC <br />FIRE SI HINKLERS RED <br />BASEMENT <br />MECHANICAL <br />' <br />❑ YES ❑ NO <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />' <br />OTHER <br />REASON <br />S i ATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />DATE <br />TAX CODE IS 3105 <br />