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APPLICATIO -. FOR CONSTRUCTnN <br />PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />BUILDING DEPARTMENT <br />259.8810 <br />❑ DEMOLITION i 1 COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING I I SIGN <br />OWNER MAIL ADDRESS CITY d l\iIP PHONE <br />L' <br />IAk%,&\O S 5� 4 o C��3 <br />1QA IN <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 21P PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />STATE LICENSE & <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />STATE LICENSE& <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />*e- v-coP r-v x -*,S o ajj.4 �h, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOt BLOCK OF — <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />O E <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 296.2DO WAC. <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />1 <br />PROJECT ADDRESS <br />NA IS <br />LITYB INESS LICENSE NO <br />Pumel O <br />MEGMANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIO—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />1 <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />1 <br />' <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />Fun UFFI" Uoc <br />FRONT SETBACK <br />WI7L1: <br />REAR SETBACK � <br />SIDE SETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />i-, YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />TYPEOF CONST. <br />NO. OF STORIES <br />UAu°AN:Y <br />G".° <br />NO Of MEILING UNITS <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG. <br />FIRE SPRINKLERS AEG <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />1 <br />OCCUPANCY LOAD <br />O <br />FIRE ALARM RE0 <br />HEIGHT LIMITATION <br />OTHER <br />I <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE <br />CITY OFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />5 <br />