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APPLICATIM <br />FOR CONSTRUC"N <br />PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: �1 GAS <br />❑ELECTRIC 0 <br />___ - -. <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION <br />COMBINATION <br />❑ BUILDING <br />["ECHANICAL <br />LI PLUMBING 1 1 SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />A <br />L'A2aou- /elq <br />J,kG'r fA fh/ <br />Fair. 9FRmI zs9-63ZZ <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHITECTOR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CON(^ACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />MECHANICAL COATRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE I <br />i�w f 4 Y oNlG <br />I T,oz r <br />L�J 8 6tlT 9ROD <br />35�-33✓`/ <br />sc�diNc tx <br />PLUMBINGGONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE IN <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED,: <br />CONTACT PERSON AND PHONE NO <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 />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT- BLOCK ­ OF <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 />CONTRACTORS 8.2 CW AND 296.200 WAC, <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />scNauBF B^rl <br />CRY BUSINESS LICENSF NO <br />DNA✓' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />URINAL <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 />' <br />SINK (SERVICE —BAR. ETC.) <br />i <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL <br />rum urrwm var. <br />vL.ii­l. <br />FEE <br />RECEIPT NO. <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECN UMBER <br />/aCo S <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />Cl YES ❑ NO <br />TYPE Of CONSi. <br />NO. Of STORIES <br />oauvANCY <br />NO Of VMILNKUMBs <br />' <br />:ABuc <br />PLUMBING <br />MECHANICAL <br />I <br />' <br />SIZE OF BLDG, <br />FIRE SPRINKLERS REGD <br />BASEMENT <br />❑ YES G NO <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCY LOAD <br />FIRE ALARM REO D <br />HEIGHT (IMITATION <br />OTHER <br />� <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE By <br />CITY OF EV ERETT <br />PUBLIC WORKS <br />=APPROVED <br />CAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />