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TO BE COMPLETED IN BLACK INK —PLEASE PRINT `,,rL"-7wn <br />HEATING SYSTEM: <br />AS J ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION <br />❑ COMBINATION <br />I I BUILDING <br />MECHANICAL ❑ PLUMBING IJ SIGN <br />OWNER <br />MAILADDDRESS <br />60155 <br />CITY <br />�yZIIPP PHONE <br />63� <br />Q kra <br />,-SS �N �S� <br />/ I4(1G � <br />P� <br />-/01 <br />TENANri.TJI, <br />MAIL <br />CITY <br />ZIP PHONE <br />ARC?Cj OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL - <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSER <br />MECHANICAL CONT nTOR MAIL ADDRESS CITY ZIP PHONE STATE LI TENSE <br />n,�,). - <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE WAIT, L.ULNSEN <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />skkIn C Y n <br />- <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 CC`:STRUCTION. TEAT 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 RC/W AND 296.20000 WAC <br />�f �/(,C,A•iiiYYY�K���"��CLL.+��� <br />A• / / ^ Vn. . I! .� c <br />PROPOSED G <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIE S) <br />LOT BLOCK CF <br />- <br />— <br />PARCEL TM LO. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PR DDRESB <br />Or� � I,n <br />GGNAiUPE DATE <br />CITYBUSINESS 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/HNDLG 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 />_ <br />i <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />_ <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />HWATER <br />HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />gM <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE. $ <br />' <br />riNn nronc � Eec nw v. <br />rvn v <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBEREEE <br />Ll <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />' <br />TYPE OF CONSI. <br />NO. OF STORIES <br />WUPAKI <br />"OU, <br />NO OF vw[uING UNITS <br />MECHANICAL <br />SIZE OF BLOC. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />7 YES NO <br />ADDI,IONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD <br />FIRE ALARM REDD <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLICWORKS <br />' <br />--TINTAKE BY <br />PUNSAPPROWED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />