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APPLICATIC l FOR CONSTRUCT'_IN PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: GAS j ELECTRIC J _ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING XMECHANICAL I I PLUMBING SIGN <br /> gI(ef(e Coq �naAlta 6E10 ST'S S+ Si►J �,?e�+�1 SS CITY TIP (zo6SN a9-2110 <br /> TENANT AIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> FRAIL CONTRACTOR MAIL ADDRESS CITY DP PHONE STATE LICENSE R <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CRYZIP PHO JE STATE LICENSER <br /> c ck�AA. ,\,AA � 4�1� 1 1�ve w k(, 48033 (1, bZS a A& q£LxA 5 M3a 5 LT <br /> PLUMBING CONTRACTOR —MAIL AUUT`tbb CITY 71P PHONE STATE LICENSER <br /> y(CONTRACT PRICE OF WORK <br /> �OESCRIB WORK ANO SQUARE FOOUGE INVOLVED CONTACT PERSON AND PHONE NO <br /> _ I HEREBY CERTIF( THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 5 F R PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH TWO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK- OF 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 /> PARCEL TAXI D NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. / (' <br /> CONSTRUCTION LOAN LENDER.ADDRESS.TELEPHONE NUMBER <br /> SKIN'C-%� <br /> PROJECT ADDRESS o [ RATE <br /> CITY ROSH 11 1 Nr, <br /> PLUMBING l� A MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC—AIHNDLG UNITS—H.P. ' <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> T— UNIT HEATERS—B.T.U. M <br /> LAVATORY(WASH BASIN) <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD ' <br /> WATER HEATER <br /> LAUNDRY TRAY T <br /> CLOTHES WASHER I WOOD STOVE ' <br /> ' METAL FIREPLACE(WOOD BURNING) <br /> URINAL ' <br /> ' FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN ' <br /> FLOUR DRAIN <br /> 1 HEAT PUMP ' <br /> 1 <br /> BACKFLOW PREVENTERS ; GAS PIPING.\ <br /> ROOF DRAINS—RAINLEADERS ' EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) i 1 <br /> 1 ' <br /> 1 <br /> 1 <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ T PERMIT $ <br /> TOTAL FEE $ ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> 610E SETBACK PLAN CHECK NUMBER r I 1 RECEIPT NO <br /> FRONT-SETBACK REAR SETBACK <br /> � O <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES 7.1 NO BUILDING <br /> TYPE OF CONST NO OF STORIES DCC~, RR aoAEulAc acs -- —....— ..--- <br /> �j0 PLUMBING <br /> SIZE OF BLDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL <br /> P YES C NO <br /> ADDITIONAL PUN CHECK <br /> OCCUPANCY LOAD FIRE ALARM REDO HEIGHT LIMITATION <br /> OTHER <br /> REASON <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL ' <br />