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APPLICATIC -" FOR CONSTRUCT"71N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: LJ GAS ❑ ELECTRIC g D lL <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION 17 BUILDING Ll MECHANICAL ❑ PLUMBING I I SIGN <br />,O ER MAIL ADDRESS CITY ZIP PHONE <br />al J , He MAIL <br />6�9 33�c! st, Ederetf 9��0� 339 aoV3 <br />TENANT KfAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />,Terra r�oto"mRSiS <br />MAIL ADDRESS /J�O G (,a / d <br />Cons`}rud-ian <br />CITY <br />vcreo <br />ZIP <br />98a6/ <br />PHONE <br />STATE LICENSE N <br />SG CoN�33L1 <br />MECHANICALPIDNTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE a <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE Nn <br />,oalq/OJ� <br />'/ 7 <br />,-;'/ -IL `ice`' <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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />,I <br />I <br />PROPOSED U (]F BUILDING <br />S� <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TA%LO. NUMBER L <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />i <br />PROJECT ADDRESS <br />&Cp3-3 <br />SIGNATURE DATE <br />CITY BUSINESS 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 />/ <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 />; <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN _ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />; <br />I <br />I <br />SUB TOTAL <br />$ <br />3 <br />SUB TOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />Per sltc PLAKI <br />REAR SETBACK <br />-o>��- <br />SIDE SETBACK <br />PLANCHE KNUMBE <br />FEE <br />RECEWT NO. <br />/�?L�/ <br />USSEEZONE <br />LOT AREA 1' Ceii" <br />VACANT SITE <br />ClYES ElNO <br />FEES <br />VALUATION <br />FEET_ <br />BUILDING <br />PLUMBING <br />5 ' <br />90 i <br />TYPE OF CONST. <br />-/� <br />NO. OF STORIES <br />_z <br />OCCUPANCY <br />�NOUP <br />NOOTOAEUINGUNIIS <br />SIZE OF RLOG, <br />nT <br />FIRE SPRINKLERS RED <br />BASEMENT � <br />El YES V<O <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE ALARM3REED D <br />/N!/ <br />HEIGHT LIMITATION <br />Z t <br />OTHER <br />REASO <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPIpV�� BY <br />JJ <br />DATE g /r, 3 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />j <br />TOTAL <br />% 90 <br />