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APPLICATIC"1 FOR CONSTRUCT'IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION I\ BUILDING ] MECHANICAL ❑ PLUMBING 1-1 SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />�GLX15 17 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECIT'OR DESIGN ER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE It <br />MAIL ADDRESS <br />ZIP PHONE STATE LICENSE 11 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEE <br />/1,/ l7MA <br />CONTRACT PRICE OF WOR �jL <br />DESCRIBE WwpgRK AND SOUARE FOOTAGE INVOLVE <br />CoNS7 'uc c^ % ClT <br />CONTACT PERSON AND PHONE NO <br />.SiCZG- <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 />// Y3 <br />PROPOSED USE OF BUILDING <br />,r? % <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />4i3S/-F56 -o /5 DOo4 <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN. DER, ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS <br />SIGNATURE DATE <br />CITY BUSINESS 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—A/HNOLG UNITS—H.P. <br />BATHTUB <br />; <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 />KITCHEN SINK & DISP - <br />I ' <br />V!W <br />VENTILATION FAN <br />- <br />DISHWASHER <br />IN <br />RANGE HOOD <br />LAUNDRY TRAY <br />'W' <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />i <br />_ <br />FLOOR DRAIN <br />I HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />eAo f%cmrc I ICC f1A71 V. <br />FRONT SETBACK <br />REAR SETBAC% <br />SIDE SETBACK <br />PIAN CHECK NUMBE <br />F �_ <br />RECCE PT NO. <br />USE'ON <br />-3 <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />62 <br />/ d C� <br />i <br />TYPE OF fANST <br />NO, OF STORIES <br />OCCUPANCY <br />G9WVi. <br />NO.OP MLLING UNOS <br />MECHANICAL <br />Sf�OF B#04,' -re <br />o_v 30Sf <br />FIRE SPRINKLERS RED <br />OR O <br />BASEMENT <br />❑ YES I' - NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />'A <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />OTHER <br />; <br />REASON <br />STATE BUILDING SURCHARGE <br />ZJ <br />INTAKE BY <br />PLANS A�OVJ=D BY <br />DATE Zq » <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />