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APPLICATIC -1 FOR CONSTRUCT-INPERMIT <br />TO 3E COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM, GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION i7 COMBINATION BUILDING L' MECHANICAL CI PLUMBING SIGN <br />OWNER M. IL ADDRESS CITY ZIP PHONE <br />_— <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAILADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE& <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSER <br />-rG E/& NCZ9 nn/C <br />/970i l / <br />Z'" -- 98036 <br />77R/-Z7i3 <br />Y'n eft NA077 /G <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE• <br />CONTRACT PRICE F RK <br />LIJ� <br />DES:.RIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CON (ACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT HAVE READ AND EXAM!NED THIS <br />APPLICATION AND KNOW THL 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 />UOT BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LCCAL 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 LAW 18.27 RCW AND 296.200 WAC. <br />PARCELTAK I.D. NUMBER <br />--3 <br />/ <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />S-cNATURE 0.27/S/ BATE <br />CITY IIUSMES5110ENSE NO <br />/%3:�( �Qf-aViA �P"t-- L`✓E�Lrt �• <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 />I <br />NC—A/HNDLG UNITS—H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.TU. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />i <br />VcNTIIATION FAN <br />DISHWASHER <br />RANCE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />jACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />n nvvro IIcc nND V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />U2FEEEES <br />1 [ C <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />VALUATION <br />FEE <br />BUILDING <br />- <br />PLUMBING <br />_ <br />TYPE OF CONST. <br />NO. OF STORIES <br />@CWAN[Y <br />GppjP <br />WOI OATUNGUNITS <br />MECHANICAL <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />