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APPLICATIC'" FOR CONSTRUCT' -IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT cvc/rfrr <br />BUILDING DEPARTMENT HEATING SYSTEM: ,GAS 0 ELECTRIC J <br />259-8810 <br />❑ DEMOLITION L! COMBINATION i BUILDING MECHANICAL PLUMBING r_I SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONF <br />MECHANICAL CONTRACTOR MAIIADORESS CITY ZIP PHONE STATELICENSEA <br />,yrrrrz <br />-y EI4400IS CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE t <br />(?WIVFZ_71,iL ATPl" PWIP'RIAI P.D &-)Y o7k4 .4V4(,1VTA�,— 9,92:21 2a�_cYxg _ <br />CONTRACT PRICE OF WORK <br />�/% CAD r <br />Ca✓JM J=�/3.2d�lrt� <br />DESC IBE WOg�K�AN)D SOUR qE F00� GE INVOLVED <br />� <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 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 />CONTRACTOR LAW 18.27 RCW AND 296.200 WAC. <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />toi BLOCK of <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS _ <br />W1L J;T % - ? <br />SIGNATURE o.T—T�'f <br />myz,s..Ssuuw,z <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—A!HNDLG UNITS—H.P. <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 />VENTILATION FAN <br />I <br />_ <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 />HEAT PUMP <br />—r— <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />�— <br />SINK (SERVICE —BAR, ETC.) <br />C <br />I <br />I <br />I <br />_ SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETBACK <br />PLAN CHECK UMBERS _ <br />PEE <br />RECEIPT NO. <br />usEzoNE <br />LOT AREA <br />VACANT SITE <br />❑ YES D NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />— <br />PLUMBING <br />- <br />TYPE TOF CDNST <br />1 r <br />NO. OF STORIES <br />10 <br />OC[uP1NCv <br />c,r <br />NO IXOWFLLMG UNrtS <br />SIZE OF BLD.G <br />I/. <br />NQ al^z,.g, <br />FIRE SPRINKLERS RED 0 <br />4045, <br />BASEMENT <br />SZ YES ❑ NO <br />MECHANICAL <br />--~— <br />-� <br />I <br />ADDITIONAL PLAN CHECK. <br />NAC�Y �L�OAD <br />OCCUPANCY CCUPA��C <br />Gjn <br />FIRE ALARM REDD <br />HEIGHT LIMITATION <br />OTHER <br />R [ASON <br />IN4,6!44�1 C,i�/� �.f J� <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />JM <br />DATE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL_ <br />