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�l[xoo ry� <br />APPLICATIC'"': FOR CONSTRUCT"N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION <br />HEATING SYSTEM: 8 <br />❑ HUR PING <br />❑ ELECTRIC <br />TENANT MAILAEDRESS CITY ZIP PHuNt <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />❑ PLUMBING ❑ SIGN <br />ITY <br />ERALCON CTOP_� 1ti,✓I1 o D//I�AJI L V 1 L lM L7 Ci �vL�VLZ W Q,II PHONE- STATELICENSE• <br />MECHAIB ALCONTRLVACTTOR L DRE S CITY ZIP PHONE STATE LLICLCEE/`N_StEvni`Cr�JT `r�Ll�10 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE .STATE LICENSE# <br />CONTRACT PRICE OF WORK I� <br />IBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />nuo <br />n <br />�l l� <br />I HEREBY CERTIFY THAT IHAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />IUS BUILDI <br />PRIM, <br />t <br />PROVISIONS OF LAWS ANDORDINANCESGOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT— BLOCK OF <br />AU T HORITY 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 />CONT CTORS LA 6.27 RCW AND 296.200 WAC. <br />Z <br />LC13,9 <br />PARCEL TAX I.D. NUMBER <br />5b��1-oi�1--0�1� <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS <br />SKINAI E OATE - <br />GITY B'MINE94LICENSE HO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF <br />CLOSET (TOILET) <br />A/C —A HNDL.G UNIBATHTUB <br />FORCED AIR SYSTLAVATORY <br />(WASH BASIN) <br />I <br />MEOUTMEtRFEEWATER <br />UNIT HEATERS—B.SHOWER <br />CLOTHES DRYERSKITCHEN <br />SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGEHOOD <br />LAUNDRY TRAY <br />' I' <br />;' _ <br />'WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />' <br />I <br />' <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />4U <br />PERMIT $ <br />I <br />' <br />PERMIT $ <br />TOTAL FEE $ <br />i p0 <br />TOTAL FEE $ <br />FOR OFFICE USE <br />ONLY: <br />RECEIPT NO. <br />FRONT SETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />FEES VALUATION <br />FEE, <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />BUILDING <br />TYPE OF LONSL <br />NO. OF STORIES <br />OGwvAxc <br />NO Of MILLING UNITS <br />' <br />GNgIP <br />PLUMBING <br />' <br />MECHANICAL <br />' <br />SIZE OF SLOG. <br />FIRE SPRINKLERS RECID <br />BASEMENT <br />❑ YES ❑ NO <br />; <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCY LOAD <br />FIRE ALARM REC'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />' <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />i <br />DATE <br />