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APPLICATION FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS <br />U ELECTRIC <br />U <br />ILDING DEPARTMENT <br />-8810 <br />DEMOLITION <br />F) COMBINATION <br />'! BUILDING <br />i.IMECHANICAL <br />PLUMBING fl SIGN <br />CAREN <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PII✓IE <br />&t04 E F. POVZ <br />ZZAI&'•QBrAadg <br />AW, 66469Er7 <br />9B'Z42Y <br />Aaxs-LSL-"yic <br />TENANT <br />MAIL ADDRESS <br />City <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />SELF <br />MAIL ADDRE,�,S <br />City <br />ZIP <br />PHONE <br />GENERAL Cp1tRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />SFA F <br />MECHANICAL Cg11NACTCR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />MACNE <br />STATE LICENSE <br />PLUMBING CONTRACTdI <br />MAR ADDRESS <br />CITY <br />ZIP <br />PRONE <br />STATE LICENSE <br />CpI1RAC1 PRICE d WgIN 1 �J <br />5 �OQ l -7< .`a <br />DESCIIIPE NiMrt AND SDuANE ICOTAGE MYCLII <br />_/Lli t o <br />CON1ACt PERSGN AND PHONE NO <br />L/ G AA2$%-S'gi-Seflle <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 IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW IS.27 RCW AND 296.200 WAC. <br />PAOroSED Usr DE BUABAIG <br />r"'AL DESCRIPTION CE PROPERTY SNCAYN BELOW OR ATTACH TWJ CCPUESI <br />BLOCK OF <br />— <br />- <br />PARCEL Tex IO NLMBE= _ <br />CCNB1gNCICN LWNI[NDER. ADDRESS IELFPHOHE NUIMBFR <br />PROJECT ADDRESS <br />2 2 <br />wL <br />nT. wswuLcrrn Hl <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-A HNDLG 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 />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />DRAIN <br />HEAT PUMP <br />_ <br />_FLOOR <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE —BAR. ETC.) <br />ti- <br />SUB TOTAL $1 <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT f <br />TOTAL FEE $ <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FACER SETBACK <br />SID <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />THE !G <br />RECEIPIND <br />USE ZONE p <br />4--'2 <br />LDTAR•EEAA <br />OOO <br />vACANTSITE <br />C YES ;^- 0 <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />7777)sL <br />TYPE C, CpKT <br />ND OF SIDRIES <br />{m/AIL nVPXILKNPL <br />uI�P <br />PLUMBING <br />SIZE OT BLDQ <br />1 16 S f <br />FIRESPRMKLCRSRECED <br />BASEMENT <br />F YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />DCCuPAHCrLao <br />RREALARMREOD <br />HEGHILIATATiCN <br />Z' <br />OTHER <br />REASON <br />I} <br />STATE BUILDING SURCHARGE <br />6(� <br />INTAKEBr <br />}� <br />Hors APPNOYED OYm' <br />u <br />D,r, ZD <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />D ; 00 <br />