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APPLICATIC : FOR CONSTRUCT""IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />BUILDING DEPARTMENT <br />259.8810 <br />f j DEMOLITION LI COMBINATION I I BUILDING MECHANICAL o PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP tI(I PHONES <br />GE RAL CON�T�R/'CTOR <br />MAIL ADDRESS CITY <br />ZIP " q PHONE <br />STATE LICEI E R <br />dr%I/C✓ <br />l%) W it I <br />f �i�1�TtL ZU i( fI.II <br />ICENSE0 <br />Y <br />CITY <br />Zip PHONE <br />STATE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE R <br />CONTRACTOR <br />MAIL ADDRESS <br />`PLUMBING <br />T <br />CONTRACT PRICE OF WORK <br />toOD <br />DESCRIBE WORK AND SQUARE FOOTAGE INCOLVED <br />CONTACT PERSON AND PHONE NO <br />U � <br />� 1-fAr.c, Foul �(� F v�- FU <br />'J LJ I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />ROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />TWO COPIES( <br />LEGAL DESCRIPTION OF PROPERiV (SHOWN BELOW OR ATTACH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOT <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMNNCE 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 WAD, <br />PARCEL TAX LD. NUMBER L• �Q0(2 <br />- <br />NDER. <br />CONSTRUCTION LOAN LEADDRE S T 'PHONE NUMBER <br />SroNATURE DATE <br />PROJECT <br />p <br />ADDRESS CFC�C }-- <br />uTv Ruswcss <br />IicENSL No <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />A/C-AIHNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />FEE <br />NO. <br />DISHWASHER <br />LAUNDRY TRAY <br />11 <br />WATER HEATER <br />WOOD STOVE <br />' <br />CLOTHES WASHER <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />FIREPLACE INSERT <br />; <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />' <br />BACKFLOW PREVENTERS <br />EXHAUST FAN <br />' <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE --BAR, ETC.) <br />' <br />I <br />SUBTOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />/ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE <br />ONLY: <br />RECEIPT NO. <br />REAR SETBACK <br />SIDE SETBACK <br />FEE <br />PLAN CMECK((''JJJJ <br />„ <br />FRONT SETBACK <br />�UpIBEf}.R <br />JYY <br />LOT AREA <br />VACANTSITE <br />FEES VALUATION <br />FEE <br />USE ZONE <br />El YES El NO <br />BUILDING <br />PLUMBING <br />I <br />TYPE OF CONST. <br />NO.OF STORIES <br />NEVIAc, NO OEIINTLLIM UNITS <br />GROUP <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REG'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BE SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />