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APPLICATIO.J FOR CONSTRUCTI, JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />,_1 DEMOLITION <br />I COMBINATION <br />BUILDING <br />MECHANICAL i <br />PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS' <br />CITY <br />ZIP <br />PHONE <br />TENANT <br />MAIL AD':HESG <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDHESS <br />-:TV <br />?IP <br />PHONE <br />GENERAL CONTRACTOR <br />IAAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE A <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAILADDRESS .O a5b77 <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE R <br />0.. /JA <br />_ <br />r- <br />nJ, <br />— .— __v., <br />O <br />U NEW Ll ADDITION i I ALTERATION REPAIR DEMOLITION I � WOODSTOVE/FRPL INSERT I Rull nwr. RFI nr.ATInM <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <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 'KITH THE STATE <br />ANN96.200 WAC. <br />CONTRACTORS LAW 18.27 RC,W��// <br />X mWWx(JC / —//n -� Z <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK of <br />PROJ5T ADDRESS <br />7✓ �I S QF <br />II <br />—©� <br />51GN.URE GATE <br />CITY BUSMESS LICENSE 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—A/HNDLG UNITS—H.P. <br />, <br />Z <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />; <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />; <br />, <br />SUB TOTAL <br />$ <br />; <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMOkp <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />YPE OF CONTS, ALLOWABLE <br />TYPE OF CONST ACTUAL <br />DMUTA"ll <br />NO 01(MILLI41 UNITS <br />GROUP <br />1 <br />PLUMBING <br />' <br />SIZE OF BLDG, <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />j <br />OCCUPANCY LOAD FIRE SPRNKLERS REO D HEIGHT LIMITATION <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED B" <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />— <br />TAX CODE IS 3105 <br />TOTAL <br />i <br />