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APPLICATIP4 FOR CONSTRUC"N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS a ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION 1 COMBINATION BUILDING 1 1 MECHANICAL I_I PLUMBING [.I SIGN <br />OWNER MAIL ADDRFSS CITY ZIP PHONE <br />6IBSON, MoNIKA 3804 MUKILTEO 13L-VD tVERt7T WA 982013 ZD6-348-3430 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />N/q <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />OW N EF2 <br />MECHAIII CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NOjV.' A ON I/� <br />vp <br />FAY I pS ON <br />REMOVE 2 LAYERS OF RDOF IN$rALL �6* <br />20�o1353 -(0591 (W <br />QLYWCO'D , INSrALL 40YR ASPNauLT 5 <br />_ <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 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 />CO CTORS LAW 1 7 RCW AND 296.200 WAC. <br />q 3 q_'L— <br />scruruRE DATE <br />PROPOSED USE OF BUILDING <br />RES I'DcNC_E <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />EDGE WA'fE:R 15LK O'K1 U-oz — <br />N SLY �5 OF IaS LESS ST j2 <br />PARCEL TAX I . NUMBER N 3 3 ro oCo-O�s - ozo7 <br />- <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />N/A <br />PROJECTAJDD'R^ESS r �T /(, T <br />3 0�1 MU ( TEO -6LVD EVE. rl <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 />AIC-AIHNDLG 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 & DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�- <br />_ <br />LAUNDRY TRAY <br />; <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 />; <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />I <br />SINK (SERVICE —BAR. ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />L01'AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDINGl <br />(J7 <br />TYPE OF CONST <br />NO. OF STORIES <br />OCtUP"CYI <br />Oxwv <br />NO aMILLING uxns <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RED <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I UBLIC WORKS <br />TOTAL <br />