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APPLICATIC] FOR CONSTRUCT73N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT �w <br />BUILDING DEPARTMENT `- <br />259-8810 <br />HEATING SYSTEM: Ll GAS U ELECTRIC ❑ <br />BUILDING I 1 MECHANICAL <br />1 SIGN <br />MAIL ADDRESS <br />CITY <br />[Ir •�^� / <br />PHONE <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />4ga°i s�- <br />�19 <br />a q3� <br />VI2v <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />CITY <br />ZIP PHONE <br />STATE LICENSE P <br />GE R L�C�O�NT(R1AJC,TOH <br />MAIL ADDRESS <br />ZIP PHONE <br />STATE LICENSE <br />/� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />CITY <br />ZIP PHONE <br />STATE LICENSE t <br />PLUMBINGCONTRACTOR <br />MAIL ADDRESS <br />CONTRACT PRICE Or WORK <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE <br />FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXI.D.NUMBER <br />CONSTRUCTION LOAN LENDER. <br />OF <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOOR DRAIN <br />BACKFLUW PREVE <br />ROOF DRAINS -RA <br />SINK (SERVICE-BI <br />FOR OFFICE USE ONLY: <br />OR <br />3UB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FRONT SETBACY. <br />BEAR SETBACK <br />L:SE ZONE <br />LOT ARFA <br />NO. OF STORIES <br />EfCONST. <br />:SIZEG <br />FIRE SPRINKLERS REO'D <br />,......�...a V I n.n <br />FIRE ALARM REOD <br />REASON <br />INTAKE BY PLANS APPROVED BY <br />DATE <br />FEE <br />l— <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 CONS rRUCTION 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 />DALE <br />SIGNAiIIRF _ <br />7V m ICMFSS l ICCNSE NO <br />NO. <br />ArC—AMNDLG UNITS—H.P. 11 <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M ' <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />_PERMIT S <br />TOTAL FEE $ <br />SIDE SETBACK <br />PI AN CHEEK N amen -- <br />� i3�,,,- <br />FEES <br />VALUATION <br />FEE <br />VACANT SITE <br />❑ YES '�� NO <br />BUILDING <br />MCUPANCN NO Of RMLLING UVIS <br />GADJP <br />PLUM <br />BASEMENT <br />MECHANICAL <br />1 YES i' NO <br />ADDITIONAL PLAN CHECK <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />