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APPLICATIOkv FOR CONSTRUCT[', N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />259-8810 <br />1 1 DEMOLITION 1.1 COMBINATION I=J BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESd CITY .tIP PHONE <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />hA{ Mg <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />Mr <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />,'.'=m 1NICAL CONTRACTOR MAIL A <br />NaKoY~,t�h g�uR�tnFA� <br />DRESS CITY <br />ZIP <br />PHONE <br />7,34 <br />STATE LICENSE A <br />3117 Ssao <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CON <br />:TyRJJACTA.`.PRICE OF,,ITVORK <br />DESCRIBE WORK AND SOLARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />NA, - Qo <br />��Lyy <br />O IC S <br />Y5 <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 />CONTR RS LAW 18.27 RCW AND 296.200 WAC. <br />/ <br />!/L - <br />PROPOSED USE OF BUILDI <br />S _ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOi BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />LINSTRUCTION LO- AN ER. LENDA.OURrEIEP��HONE NUMBER <br />/-,O <br />PROJECT ADDRESS <br />CIG FIUPE 041E <br />CITY BUSIM1E55 Er6E 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 />NC—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. N: <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN q'jk I4mom <br />T <br />DISHWASHER <br />( <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER _ <br />CLOTHES WASHER <br />—�— <br />_ <br />WOOD STOVE <br />_ <br />URINAL <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />I <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />_ <br />SACKFLOW PREVENTERS <br />i <br />GAS PIPING . <br />ROOF DRAINS—R.AINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />SUB TOTAL <br />$ <br />SUB TOTAL <br />PERMIT <br />S <br />I <br />PERMIT $ <br />6o <br />TOTALFEE <br />$ <br />' <br />TOTALFEE $ <br />Eno nCCIPE I ICE nFJI V. <br />`l S p-i 0 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PFE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />n YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />T <br />BUILDING <br />PLUMBING <br />-- <br />TYPE OF CONST <br />NO OF STORIES <br />occUPNar <br />GRWP <br />No of pY/RIING UNITS <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BV <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICWORKS <br />TOTAL <br />