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• APPLICATION FOR CONSTRUCTION PERMIT 477. • . • <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: CI GAS CI ELECTRIC I <br /> 259-8810 <br /> • 0 DEMOLITION 0 COMBINATION 0*ILDING 0 MECHANICAL 0 PLUMBING ❑ SIGN ' <br /> OWNER MAIL ADDRESS CITY ZIP PHONE '. � <br /> • <br /> C e..- 3oorL� 02 A(!�- V... <br /> fyoia..,Ele ee t't • �\ <br /> TENANT MAIL ADDRESS v CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> • <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE# <br /> ucad.e.4. 41.1 C4. tru•cflaH 33WO _/.4`f 1 54.14-& i8A`l7 I/3.O'1I3 BRAZE Ac-( NZ . <br /> • <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE# <br /> PLUMBING CONTRACTOR - MAIL ADDRESS CITY ZIP PHONE STATE LICENSE# • <br /> CONTRACT PRICE OF WORK .. <br /> 8 400 92/h <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> (3 4441. a H x a y Fa,rags 634 s.Pr. rwu(e.J A!le•) 7/3-o 513 • <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEQLIRE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � t PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF .. <br /> LEGAL DESCRIPTION O PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK OF 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 /> PARCEL TAX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> AiSI8 -5-4/9 "•ooq —o.00 4( <br /> CONSTRUCTION LOAN LENDER,ADDRESS,TELEPHONE NUMBER - <br /> PROJECT ADDRESS (� /- - SIGNAT E DATE <br /> 2 q/7 V AJ f�l um c(_) CITY BUSINESS LICENSE NO. <br /> PLUMBING JI MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. i <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> • DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER • <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> • <br /> SUB TOTAL $ SUB TOTAL $ <br /> • PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE SEC PT NO. ' <br /> l/l 141 7(0 2 Hof 0 • <br /> USE ZONE LOT AREA VACANT SITE EES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING <br /> TYPE OF CONST. NO.OF STORIES OCCUPANCY NO.OF DWELLING UNITS <br /> GROUP PLUMBING • <br /> SIZE OF BLDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL <br /> • <br /> ❑ YES ❑ NO <br /> OCCUPANCY LOAD FIRE ALARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> OTHER <br /> REASON -. .. ,. <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL <br />