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APPLICATIC-`' FOR CONSTRUCT!1N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ,GAS ❑ ELECTRIC J <br />259-8810 <br />II DEMOLITION COMBINATION I BUILD IG � MECHANIIC�AyL �y LiPLUMBING ❑ SIGN <br />OWNER ;;;D3 jS . ITY 77J ZIP W PHONE <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSED <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE III <br />&aatAA&I5W7J'Sy/1 � /C�/E..fJ9.P/IFU/F��o%JP. <br />EG. <br />1or ZSL-�iy <br />iEIIGSS�zlf7 <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSER <br />CONTRACT PRICE OF WORK 011 <br />'05�%O <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO, 2 <br />PROPOSED USE OF BUILDING <br />EA/�/ C_ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />DJECT ADDRES <br />/o <br />PLUMBING <br />O. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN _ <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICL-BAR, ETC.) <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 CONSTRUCTIC'I OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZ ) BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FI i WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TH_ STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />AIC-A HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BUF <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />Q <br />PERMIT $ <br />��- <br />PERMIT $ <br />TOTAL FEE $ <br />_ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH CK NUMBER <br />33-7D <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />I <br />TYPE OF CONST. <br />NO, OF STORIES <br />OCCUNINCY <br />Gnouv <br />NOGIDN11LINGUN115 <br />SIZE OF BLDG. <br />FIRE SPRINKLE iS REO'D <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />, <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />