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APPLICATIQM FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: Ll GAS <br />U ELECTRIC LJ <br />BUILDING DEPARTMENT <br />_--- --- <br />259-8810 <br />1 DEMOLITION <br />I I COMBINATION <br />I I BUILDING <br />✓MECHANICAL I I PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />71P PRONE <br />3 o N Cxaouv- <br />2'731 WCTv-arc <br />j6 L* Ewxs:m,y* <br />16 im - 00 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL AUORESS <br />zip <br />GENERAL CONTRACTOR MAIL ADDRESS City ZIP PHONE SIDLE OCrrvStR <br />j:jqtjj <br />ATRIer wl.� y�pq A 'gb'^bW e. Gs 4 'TA��►M. v.� 9812�► 9?L-2290 1Tp.TR1FPC'l9GR <br />MECHANICALCCNTRAGIOR MAIL ADDRESS City ZIP PHONE STATE LICENSER <br />P <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CONiMC11+; PRICE OF WORK <br />CITY <br />PHONE STATE LICENSE R <br />W 1 R-L jr <br />_— <br />--- <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PANNE NO <br />FZQTsao •F TT A GON1rLLTE A-rm LAAhame- <br />_-- -- <br />'Dxa�,.>'� E=eooaa 92� • 2290 <br />A.� F.r.►sm <br />�aPe+F•+�cL es- Te.rr.Tw ustu <br />_ <br />k: S^'CX>0 `alQ. FT. CS)_0 Da._< P�`,1�L-oL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORF7ECi. ALL <br />PROPOSED USE OF BUILDING <br />SIrP.[.[ IiAJ►�..t'1�A GL�y1` <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTIONOF PROPERTY ISNOWN BrLOWOR AnnCN TWOCOPIESI <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />- - --- --- <br />_ <br />PERFORMANCE OF CONSTRUCTION, 11IAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />---- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONI RACTORS LAW 18,27 RCW AND 296.200 WAC. <br />/� JB- <br />PARCEL TAX I D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />EOT AEU FOSS ' <br />Q,aQ*r ' �{.IQTMOeE. A+.1E <br />rrTrr O�To9� nATF <br />__ <br />cnr nvsnn ssl KrNs no <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.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />( <br />WATER HEATER <br />L_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFPREVENTERS <br />� <br />GAS PIPINGLOW <br />r <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />r <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I <br />_ <br />r <br />I <br />T <br />I <br />SUBTOTAL $ <br />; <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SFiBACK READ! <br />ITSE ZONE <br />RK <br />BY <br />LOT AREA <br />NO. OF STORIES <br />FIRE SPRINY.L�ERyS�REOD <br />I RS <br />LOAD FIRE ALARM RF.O❑ <br />Y�� <br />PLANSJAPPROVEDBY <br />DATE <br />SIDE SETBACK <br />VACANT S1TE <br />❑ YES ❑ NO <br />M{UI'I.NCY NO fI MIf1111M IINlIi <br />GR(MP �i <br />)k YES 17 NO <br />HEIGIR LIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />' <br />OTHER <br />STATE BUILDING URCHARGE <br />PUBLIC WORKS <br />TOTAL <br />I <br />