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APPLICATIOr FOR CONSTRUCTMN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: ❑ GAS YdELECTRIC <br />—J <br />259-8810 <br />DEMOLITION COMBINATION <br />MAI, <br />MAIL ADDHESS <br />BUILDING X MECHANICAL <br />CITY _ ZIP PF <br />CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING SIGN <br />GENERAL CONTRACTOR <br />MAIL AD SS .� <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />MECHANICAL CONTRACTOR <br />MAIL POD/RESS <br />CITY <br />21P <br />PHONE <br />STATE LICENSE <br />�YaL I✓AEcN I <br />ac a -i�o1C 7 11140 <br />SEA • WAg H. <br />( t D7 <br />799 -�;01-41 <br />LoN[,1LMI 141 OK. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATF. LICENSER <br />CLASS OF WORK <br />X NEW )4 ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />-/q AAq <br />CONTRACT PRICE OF WORK V,. `'lU <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SOUARE FQlIbTAGE INVOLVED <br />AAM&IIobl rn crYIct <br />PROPOSED USE OF BUILDING <br />QAU 1F, 61 L ITV <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 ! COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW ANL' 296.200 WAC. <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOWORATTACH FOUR'OPIES) <br />LOT BLOCK OF <br />g I C2 LD7 (ti 4 G All/ E PAE Q / <br />PROJECT ADDRESS <br />C � F I �1L,S1I Nrl vc- <br />E ( <br />_ <br />SIGNATURE DAIS <br />CITY ROSINESS -ICI NSF NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OP'TEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />kC—A/HNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />02, <br />UNIT HEATERS—B.T.U. M jC CVO' <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />4ENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' I <br />HEAT PUMP <br />T <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAU T FAN <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />3 <br />s X c <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />a - <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMMBERr <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />F?E <br />BUILDING <br />_ <br />TYPE OF;ONTS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />OCGUPANLY <br />NO OF MILLING UNITS <br />GROUP <br />PLUMBING <br />SUE OF BLDG, <br />NO. OF STORIES <br />-I <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO'D HEIGHT LIMITATION <br />SPRINKLER <br />i <br />REASON FOR SPRINKLERS <br />-- <br />—_T <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />I PUBLICWORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />1 TOTAL <br />