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----gPPLICATIQ I FOR CONSTRUCTS )N PERMIT <br />/ 'I) TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: WGAS ❑ ELECTRIC O <br />259-8810 <br />I_I DEMOLITION I COMBINATION 11 BIIILDING KMECHANICAL CI PLUMBING ❑ SIGN <br />.NIA All ACIDNESS ..1 CITY bP PNONE <br />TENANT MAE.ADDRESS CITY ZIP Iw2 <br />AK417ECTMOESCUER MAA.ADDRESS CRY ZIP PHONE <br />GENERAL CONTRACTOR MAA ApOlE55 CITY ZIP Pill STATE LICENSE <br />6UTO?A WSal ivc. 21)2i 9C.Ef, tJ 8000io( 9RO2io 7U=oY2J- [:11of6 //o4A1 <br />MECHANCALCONTRNCTOR MAIL ADDRESS CITY ZIP PHONE STATELCENSEF <br />PLUMBING CONTRACTOR MALM)DRESS CITY ZIP PHCME STATELICENSE• <br />1RACTNTCEOFNONt <br />0 <br />SCRMFNV��/�R71N AND SQUARE FOOTAGE WVOLWO <br />CONTACT PER5CN AND PHONE NO. <br />fY1&dl,04 u. <br />4 <br />J <br />I HEREBY CERTIFY THAT 1 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 1 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 WAD, <br />x <br />PROPOSED USE DE BU LOING <br />LEGAL DESCRIPTION OF PROPERTY ISiBAYN BELOPNOR A"MM TYVO COPVSI <br />LOT BLOC" OF <br />PARCEL TAX I D NUMBER <br />CONSTRUCTICN LOAN LENDER. ADGRESS. TELEPHDPANUMBER <br />7'ft? Id Al 1 7tFo <br />PROJECT ADDRESS <br />R�SM391[LNY W <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF hIXTURE OR ITEM <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CI OSET (TOILET; <br />AIC-A)HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.TU. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />:FEENO. <br />RANGE HOOD <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 />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERSL <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />SUBTOTAL $ <br />iijm <br />PERMIT S <br />_ _$ <br />TOTAL FEE $ <br />CAM neelre F FCC nMF V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIBEBETBACK <br />PIANpECK MAB[P <br />Ill <br />RECE MRN <br />USE ZONE <br />LOT AREA <br />VACANT BEER <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />TYPFCFEDNST <br />NO OtTOTIEs <br />t¢TIAI[Y IavLRLIIIAIAItf <br />olol <br />PLUMBING <br />SMEOFBLOD <br />FIRE SPRWCE US REM <br />BASEMENT <br />MECHANICAL <br />YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE A, PIA RIG <br />HECHTLYRATKIN <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />NTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUDLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />