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APPLICATIO( <br />FOR CONSTRUCT[ <br />A <br />PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: L] GAS ❑ ELECTRIC <br />❑ <br />BUILDING DEPARTMENT <br />259 8810 <br />DEMOLITION LI COMBINATION <br />❑ BUILDING JY MECHANICAL <br />❑ PLUMBING t I SIGN <br />01 MAILADDRESS <br />CRY ZIP <br />PONE <br />ZA'ArI,Zq 0444-2zn IT74 iGzl <br />i+/lA)A=I� Ad ,eAEZa 9920l <br />ZSB`Y9C9 <br />TENANT MLADORESS <br />CRY ZIP <br />PHDNE <br />ARCHRECTORDESIGNER MLADDRESS <br />CRY ZIP <br />P,q <br />GENERALCCNTRACrINT MAL ADDRESS <br />CRY ZM <br />PH E <br />STATE LICENSE <br />MECBWOALLON1rUCT011 MLADDRESS <br />CRY ZIP <br />PHONE <br />STATE LKENSEF <br />FIA=A->n// .a09 <br />/�"Yn7 /� Y/S .cIGEO,F-7T <br />�/B2o/ 35-33sys/ <br />RWBWD LONTMCl011 MAL ADDRE59 <br />CITY NIP <br />PNDNE <br />STATE LICENSE <br />990E— <br />CON7RACT PRICE OF NORK <br />ZSo '- <br />DESCRIBE WdM ANO SQUARE FOOTAGE INVOLVED <br />CCNTACi PERSIXI AND PNONE NO <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED "HIS <br />APPLICATION AND KNOW THE SAME TO BC TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMFLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />A, rHORITY 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 1 COMPLY WITH THE STATE <br />CONTRAC DRSLAWIB27RCWAND2962DOWAC, <br />PROPOSED" BULIWM <br />LCDAI DESCRIPTK`M OF PPWERTr ISHONN BELOA OR ATTACH IVADCOPl51 <br />LOT- BLOCK OF <br />PARCEL TAXI D NUMBER <br />CONSTRMRQIA LOAN LENDER. ADDRESS. TEIETYC'ME NUMBER <br />PROJECT ADDRESS <br />L <br />DAL <br />PLUMBING <br />M•CHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />'iQ <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AC—AHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. I.y_ <br />LAVATORY(WASH BASIN) <br />UNIT HEATERS —BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KIT :HEN SINK 8 DISP <br />VENTILATION FAN <br />_T <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METALS(WOOD BURNIND) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SEf1VICE—BAR. ETC I <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />Itt <br />PECEIPTND. <br />5 CS <br />USE ZONE <br />LOT AREA <br />VA SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />_1 YES ❑ NO <br />tYMbCONST <br />WJ CF SiORIkS <br />bLMLr <br />obMDtA4 WTt <br />MbP <br />PLUMBING <br />SIZEDROLIM <br />FIRE SPRINKLERS REST) <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />OCCUPANCY LOAD <br />FIRE HARM OEOD <br />HEXiI1TLYRAIXIN <br />ADDITIONAL PUN CHECK <br />OTHER <br />REAwN <br />STATE BUILDING SURCHARGE <br />NTAKE BY <br />PLu+s APPRDVEDer <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />