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APPLICATIC l FOR CONSTRUCTv-)N PERMIT <br />TO BE COMPLETED IN BLACK INK- PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC .J __ <br />259-8810 <br />DEMOLITION <br />COMBINATION <br />BUILDING <br />MECHANICAL <br />PLUMBING SIGN <br />A <br />TENANT <br />ARCHITECT OR DESIGNER <br />() fatie r <br />11 MAIL ADDRESS <br />MAIL ADDRESS <br />MAIL ADDRESS <br />L11Y <br />r4Y <br />CITY <br />2LIP <br />ZIP <br />ZIP <br />n PHONE <br />PRONE <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />_ <br />'P <br />PHONE <br />STATE LICENSE R <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />Zb' <br />PHONE <br />STATE LICENSE R <br />PLUMBING CONTRACTOn <br />MAIL ADORE SS <br />CITY <br />Zm <br />PHONE <br />STATE LICENSER <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FCAi INVOLVE <br />CONTACT PERSON AND PHONE NO <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 />AUTHCRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCI ION 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 " W 1 7 RCW AND 296.200 WAC. <br />s Il <br />DATE <br />PROPOSED USE OF Bl11L ING <br />P 7 ✓ Z' Z' <br />LEGAL DESCRIPTION OF PROPERTYISHOWN 8�F.�L7OWOR ATTACH TV/0 COPIES �l <br />LOT S BLOCK v=r�c�.RrJF �✓ ✓? "n i✓. n <br />- <br />PARCEL a. I n NUMBER <br />CONSTRUCTION LOAN LENDER ADDRES:;. TElErHONENUMFR <br />PROJECTADDRESS A� <br />�R�.3 iY <br />CItYA15MlESSIKI NSI Ml <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />11. <br />TYPE OF EQUIPMENT <br />FEE <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 0:151N) <br />UNIT HEATERS-B.T.U. M <br />-- <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHE9 _ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER `-IEATER <br />_ <br />CLOTHES WASHER <br />WOOF E <br />URINAL _ <br />METAL PLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PLMP <br />_T <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />S;NK (SERVICE -BAR. ETC.) <br />1_ <br />_ SUB TOTAL. $ <br />SUB TOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTALFEE $ <br />_ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />SETBACK <br />REAR SETB <br />SETBACK <br />GE SEAC <br />PLAN CHECK NUMBER <br />fLf <br />RE( LIFT NO <br />!o O <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />YES NO <br />BUILDING <br />00 <br />TYPE OF CONST <br />NO OF STORIES <br />q.C11ANP <br />xa q gHuixt urns <br />tngv <br />PLUMBING <br />SIZE OF BLDG <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />7 YES ' -. NO <br />ADDITIONAL PLAN CHECK <br />— <br />OCCUPANCYLOAD <br />FIRE ALARM REGD <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPRCVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />il <br />T <br />