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APPLICATION FOR CONSTRUCT[ -'N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />HEATING SYSTEM_J GAS <br />❑ ELECTRIC <br />J <br />259-8810 <br />DEMOLITION <br />1 1 COMBINATION <br />BUILDING <br />I MECHANICAL <br />CI <br />PLUMBING F1 SIGN <br />OWNER <br />h IL ADDRESS <br />CITY <br />21P <br />PP,ONE <br />Tavl /7 i <br />AD Rim, <br />/ <br />, ten— <br />�9- <br />�yS <br />TENANT <br />MAIL ADDRESS <br />— <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GEN LCONTRACTOR n <br />I <br />MAIL ADDRESS <br />i <br />CITY <br />ZIP <br />PHONE <br />STATE LIC:NSE0 <br />fTor �� •n4 <br />/-s�� <br />���h <br />3�� �y�/7w�73` <br />`✓ <br />o�S1�fi.2 <br />S,peire///OG <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE 8 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PNONE <br />STATE LICENSE A <br />CONTRA T PRICE OF WORK <br />DESCRIB)IWORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />-Z;a-r-12g 2'4 o� aao- <br />— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXA..:'INED 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 />CONTRAC LAW 18.27 RCW AND 296.200 WAC. <br />p� <br />' =DATE <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT— BLOCK — OF <br />— <br />PARCEL TAX I D NUMBER <br />a <br />CONSTR IC LOANLENDER. ADDRESS, TELEPHONE NUMBER <br />PROJ /pD RESS <br />slr,Nn <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 />WATER CLOSET (TOILET) <br />AiC—AIHNDLG UNITS—H.P. <br />; <br />BATHTUB <br />FCRCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) _ <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP — <br />; <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 />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />— <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />' <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />; <br />�-- <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECY NUMBER <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />'�. YES ❑ NO <br />BUILDING <br />TYPE OF CONST <br />NO. OF STORIES <br />Kw—mcv <br />NO(FDATLUNGUNITS <br />caour <br />PLUMBING <br />, <br />SIZE OF BLDG <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MECHA141CAL <br />� <br />I-1 YES- NO <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHTLIMITATION <br />OTHER <br />REASON <br />— <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />1 <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />: <br />