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APPLICATIOL FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT EATING SYSTEM: j GAS j ELECTRIC CJ <br />259.8810 <br />! I DEMOLITION I I COMBINATION I I BUILDING - )C MECHANICAL I PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />RK . co. r✓J&xzEA 38 3 <br />1ENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL <br />GENERAL <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />MAIL ADDRESS <br />CITY <br />PHONE STATE LICENSE A <br />IQCINTRACT PRIG RN <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PEASONPHONE NO p <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 CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FC, NHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/mil <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS �O _ <br />l� <br />TIME <br />CITY RUSMFSSLs INS( 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 />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATEHS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />T <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <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 />SINK (SERVICE -BAR. ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLANCHECK//NU�MBER // <br />FEE rFl <br />RECEIPT NO . <br />A-{' O�CL� <br />(—;?o <br />C'S Q <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />[1 YES F1 NO <br />BUILDING <br />TYPE OF CONSt. <br />NO OF STORIES <br />MOUTANCI <br />nOamnW ac uM15 <br />cAOJ> <br />PLUMBING <br />SIZE OF BLDG <br />FIRE SPRINKLERS REG D <br />BASEMENT <br />MECHANICAL <br />- <br />❑ YES L] NO <br />ADDITIONAL PLAN CHECK <br />--- <br />OCCUPANCY LOAD <br />FIRE ALARM REED <br />I RIGHT LIMITATION <br />07HER <br />REASON <br />STATE BUILD) G SURCHARGE <br />IN—iANE BY <br />PLAN. P,PROVED DY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />614 <br />LOCAL SALES <br />TOTAL <br />O ; Oc <br />HATL . 19 . 0 t <br />TAX CODE IS 3105 <br />