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APPLICATIO_. FOR CONSTRUCTf--')N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS >fLECTRIC ❑ <br />259-8810 <br />L! DEMOLITION COMBINATION I BUILDING ❑ MECHANICAL I 1 PLUMBING SIGN <br />MAIL ADDRESS CITY ZIP PHONE <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP L <br />PHONE <br />sRmc <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />�A me <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE A <br />SAME. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE X <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />CONTRAt I PHICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE IN\OLVED <br />CLN(sL.E I.onL <br />�� <br />CONTACT PERSON AND PHONE NO <br />sf�1 SpE�ic <br />c- ( N <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 18.27 RCW AND 296.200 WAC, <br />\ ` CC�^��Q AI� (1/ <br />x \� N�-�R /�TIFI S <br />PROPOSED USE OF BUILDING <br />j >✓ L E 1 TQ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />Lors3 �3"T CLOCK �-O'a of rn -�T - <br />u1 <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS <br />SIGNATURE Gnc <br />CITY BUSiNLSS LKLNSE b0 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <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 />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK $LISP-- <br />VENTILATION FAN <br />DISHWASHER <br />( <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />i <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTEFS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERC <br />I <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL $ <br />" <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />Cf1G f1CGICC IICC nkil V. <br />FRONT SETBACK <br />REAR SET$PCK / <br />SIDE SETBACK / <br />PLAN CH J1�/E� <br />FEE �D <br />RLC/ P /J —� <br />,`(/ <br />CT <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />FEEL/ES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />I <br />�- ^ <br />❑ YES ❑ NO <br />El <br />TYPE OF CONST <br />N TORTES <br />GCCUPANCY <br />NO GI VMLLING UN45 <br />_ <br />Rf° <br />PLUMBING <br />2 <br />SIZE OF BLOC. <br />FIRE SPRINKLERS REO'D <br />BASSEMM <br />MECHANICAL <br />3D <br />QI(a <br />o <br />,'YES 71 NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE AlA M REOD <br />HEIGHT LIIAITATION' <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APP,ROD BY <br />�(E <br />CITY OF EVERETT <br />PUBLIC WORKS <br />T <br />J I; <br />LOCAL SALES <br />DATE 9 <br />TAX CODE IS 3105 <br />TOTAL <br />