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APPLICATI" FOR CONSTRUCTnN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ]GAS ❑ ELECTRIC J — 1 <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />O��yyNER <br />Gtydoc� <br />MpIL�ADDR S <br />5"T,Sers <br />CITY ZIP Pnorvt <br />2-731 (�'�"vreCt�e,Stescc�E e(f�gt� 3RY>-�FGu --- <br />T/EN'AN,., <br />MAIL ADDRESS <br />CITY <br />ZI <br />PHONE <br />11I ('I� <br />7 <br />ARCHITECT DESI <br />MAIL ADDRESS <br />C�IZc> zz0�`' <br />CITY <br />5$ Zok mmNake <br />ZIP <br />I�rr� <br />PHONE <br />9gU43 (o�o <br />n�� yan <br />GENERAL CONTRACTOR <br />I'1 LADDBESS <br />&)o <br />CITY <br />I baS <br />ZIP <br />tjO <br />PHONE <br />a9n(-/ Q(9Rxt, <br />STATE LICENSEA <br />SDtl0 z31b4 <br />SD L Cr rP <br />P C) <br />.(levee <br />LICENSE <br />MECHANICAL CONTRACT <br />R <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />sy s <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSEE USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL EE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />COO;`S) <br />LEGAL DESCRIPTION OF PROPERTY IS BELOW OR A?TACTWO <br />T <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />YY// C[LGAA OO `` GGVV <br />LOT BLOCK Ub % 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 L CW A 6.200 WAC. <br />{/ / / <br />PARCEL TAXI D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGN4URE UL1E <br />'- <br />PROJpyCT ADDRESS r� <br />TICE NSE NO <br />C/ee <br />2 OZ O_ , <br />V� <br />CITY RUSINESS <br />MECHANICAL <br />PLUMBING <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />UNITS-H.P. <br />WATER CLOSET (TOILET) <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />FORCED <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />RANGE HOOD <br />DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY <br />WOOD STOVE <br />CLOTHES WASHER <br />I <br />METAL FIREPLACE (WOOD BURNING) <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 />SINK (SERVICE -BAR. ETC.) <br />EXHAUST FAN <br />I <br />SUB TOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOALFEE $ <br />T <br />FOR OFFICE USE ONLY: <br />FRONT SE TRACK <br />REAR SETBACK <br />LOT _AREA <br />USE ZONE <br />TYPE Of COAST <br />N. OF STORIES <br />_" <br />/ <br />SIZE OF BLDG <br />FIRE SPRINKLERS F <br />1,6 ,K/F .I. <br />Yip. <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />INTAKE BY PI ANS APPROVED BY <br />Jil DATEl�u1• <br />SIDE SETBACK <br />^^- <br />30 <br />VACANT SITE <br />FEES <br />:-, YES NO <br />BUILDING <br />ocEunevc <br />no o"II uyc IN rts <br />PLUMBING <br />BA�MENT <br />MECHANICAL <br />VES :-: NO <br />PLAN CHECK <br />HEIGHT LIMITATIONADDITIONAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOS IS 3105 <br />1 TOTAL <br />FEE <br />R <br />