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3U 27 5-y <br />APPLICATIC 1 FOR CONSTRUCT' )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J <br />259-8810 <br />X DEMOLITION COMBINATION I BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />PHONE <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />CONTRACT PRICE OF WORK <br />DESC EWORKANDSO RE FOOTAGE INV VEO <br />%vc <br />vrPS <br />CON jPE NA HONE <br />Ecsn�t/ <br />////` <br />?Ro Zi c <br />— <br />I HEREBY CERTIFY THAT 1 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 FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X afli�z ,eAe ;zee l <br />SIGNATURE WE <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPER IY ISHCWN BELOW OR ATTACH TTWOCOPIES <br />LOT / BLOCK 005-• 'o of 5'�'Oy�" �4 60' <br />n � <br />s .« FV �C!// <br />2 <br />PARCEL TAXI 0 NUMBER <br />--oos-060-oa�3 <br />CONSTRUCTION LOAN LENy� R ADO SS. TELEPHONE NUMBER <br />Y;w /Ti.� r <br />PROJECT ADDRESS <br />CITY BUYNESS L+CFNSE 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 />AIC-A,HNDLG UNITS -HP. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />i <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS-1 AINLEADERS <br />+ <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR. ETC.) <br />' <br />T <br />I <br />I <br />E <br />T <br />1 <br />SUBTOTAL $ <br />SUBTOTAL <br />PERMIT $ <br />PERMIT 5 <br />i <br />TOTAL FEE $ <br />TOTAL FEE E <br />F:nl2 nF:1:IC5= IICF nmI V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHLnNUMBER <br />IFL <br />RECBPT NO <br />3. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />G YES ❑ NO <br />BUILDING <br />TYPE OF CONSf <br />NO. OF STORIES <br />Bttuwxcr <br />T4 a UWDLIN6UNITS <br />GPg1P <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REGO <br />BASEMENT <br />MECHANICAL <br />' <br />❑ YES ❑ NO <br />— <br />ADDITIONAL PLAN CHECK <br />— <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />— <br />OTHER <br />1 <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY PLANS APPROVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />