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APPLICATIO; FOR CONSTRUCT1-N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS U ELECTRIC -I <br />259-8810 <br />i i DEMOLITION COMBINATION El BUILDING ❑ MECHANICAL XPLUMBING SIGN <br />OOMER MAIL ADDRESS CITY ZIP --- PHONE <br />l" i TY 5 F fuF DE'TT <br />MAIL ADDRESS <br />:T OR DESIGNER MAIL ADDRESS <br />CONTRACTOR /' MARADDRESS <br />:Al_ CONTRACTOR MAIL ADDRESS <br />Igwfb (ObA}< <br />(CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />CITY <br />ZIP <br />CITY <br />ZIP <br />ZIP <br />PHONE <br />PHONE <br />PHONE <br />PHONE <br />CITY ZIP PHONE <br />LICENSE <br />LICENSE A <br />LICENSE s <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I 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 CR 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 J <br />SIGNATURE �I DAIL <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TING COPIES) <br />LOT— BLOCK of <br />PARCEL TAX LD NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS n <br />3 OIC <br />CITYBOSINESSUCENSF 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 />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.I.U. M E.A. <br />LAVATORY (WASH BASIN) _ <br />i <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />; <br />t <br />i <br />SUB TOTAL $1 <br />SUB TOTAL $ <br />PERMIT $1 <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />T_ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH[C NUMBER <br />FEE <br />RECEIPT NO <br />Ja�� <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />TYPE OF CONST. <br />NO. OF STORIES <br />BccuPAxcr <br />NB aPMulxc uxln <br />B° <br />PLUMBING <br />' <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />MECHANICAL <br />�— <br />❑ YES a NO <br />ADDITIONAL PLAN CHECK <br />I <br />; <br />OCCUPANCY LOAD <br />FIRE ALARM RED D <br />HEIGHT LIMITATION <br />OTHER <br />I <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />