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t <br />1 Aft, <br />APPLICATIC 1 FOR CONSTRUCTr')N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLFASE PRINT <br />EATING SYSTEM• GAS l] ELECTRIC U _ __ _ _ _ ._ _ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION I -I COMBINATION 1-1BUILDINGU MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL ADDRESS <br />CITY Zip PHONE <br />PHONE <br />TENANT MAILAOOHLss <br />ARCHITECT OR DESIGNER MAR ADDRESS <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEA <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY 21P PHONE STATE LICENSE <br />/ /rW�E3 fy 3u�/ ZSEyE71655/z/f7 <br />d/iX'G/1!'kY f/ SiT`k ZIP PHONE STATE LICENSE IT <br />CONTRACT PRICE OF WORK <br />SO <br />DESCRIBE WORK ANDSWARE FOOTAGE INVOLVED <br />_2 <br />CONTACT PERSON ENO <br />PHON2o—/e/ <br />�— —Arlo P <br />6 s nT �F <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />I HEREBY <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />— ` <br />PROVISIONS <br />NOR LCOMPLETEDL BE THEGRANT NG OF AERMIWITH TJSPECIFIEDHETHER <br />DOFS NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SKOWN BELOW OR ATTACH TWO COPIES) <br />OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOT BLOCK <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />L <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 />PARCEL TAX I D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT <br />ADDRESS <br />cnv ous..:[ss <br />LCEKSEW <br />/n <br />Z� A/ .4 <br />/✓. <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF ENT <br />TYPE OF <br />FEE <br />NO. <br />WATER CLOSET (TOILET) <br />I <br />A'CrAHNOLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />I <br />L <br />CLOTHES DRYERS <br />' <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />RANGE HOOD <br />' <br />DISHWASHER <br />' <br />WATER HEATER <br />` <br />LAUNDRY TRAY <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />L <br />FIREPLACE INSERT <br />' <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />; <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADE13S <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL <br />$ <br />I <br />SUBTOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FOR OFFICE USE <br />ONLY: <br />RECEIPT NO. <br />FRONTSETBACIT <br />REAR SETBACK <br />SI;SEMCK <br />PLAN CHECK UMBER FEE <br />01l <br />VALUATION <br />FEE <br />USEZONE <br />LOTAREA <br />VAFEES <br />❑ NO <br />BUILDINGNOOF <br />OF CCNST. <br />STORIESlAC <br />WHSTYPE <br />PLUMBING <br />' <br />MECHANICAL <br />' <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCYLOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />I <br />NTAKE BY _T <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />