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y�pv) <br />APPLICATIO" FOR CONSTRUCTF-dNN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ' J GAS J ELECTRIC _l <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />ONRIER / J MAIL ADOPESS CITY ZIP PHONE <br />�1"I Adh14L" �.z.23- _✓CCCr— i �C -432 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADrdESS CITY ZIP PHONE STATE LICENSE/ <br />JUJ Yke <br />L'ECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />1 CONTRACT PRICE OF WORK <br />I { <br />3 DEfRIBSWORK AND SQUARE FOOTAc. OLVED <br />CONTACT PERSON ANDPHONE NO <br />le <br />4 <br />14 1-1f <br />6l5 ss rT <br />{ % <br />- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />raoPoseo US — OF emLDINc <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CGRRECT. ALL <br />AG M C <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWCCOPIES) <br />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 <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS CF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY FHE <br />'. <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TA%10 NUMBER <br />LiC7_ <br />LA 18.2' RCW AND 296.200 WAC. <br />' 3 4 - OO iO - D 05 - coo aCONTRALTO <br />C T UIC,TTIIIOONLOAN LENDER ADDRESS TFI HONENUMBER <br />/J <br />—�c� <br />PROJECTADDRESS <br />Ilmvnum nnF <br />-IF <br />CITY I.SN( SS UU NW NO <br />- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO, TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A,C-AQiNDLG UNITS-H.P. <br />BATHTUB _ <br />AIR SYSTEMS-B.T.U. M E.A. <br />LAVATOR' (WASH BASIN) <br />_FORCED <br />UNIT HEATERS-B.T.U. M <br />,j <br />SHOWER <br />CLOTHES DRYERS <br />1 <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER _ <br />_ <br />RANGE HOOD <br />�. <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREV' NTERS <br />_ <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />T <br />SUB TOTAL <br />SUB TOTAL $ <br />_ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTAL FEE $1 TOTAL FEE $ <br />FOR OE=FILE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBE R <br />FFFffVALUATION <br />L`T NO <br />USE ZONE LOT AREA VACANT SITE <br />FEES <br />FEE <br />.^ YES 7 NO <br />BUILDING <br />flPEOr CONST NO OF STORIES oCc~ WINPRTWNGUhITS <br />cAaF <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG FIRE SPRINKLERS REO'D BASEMENT <br />YES f-' NO <br />OCCUPANCY LOAD FIRE ALARM BLOB HEIGHT LIMTAHON <br />ADDITIONAL PLAN CHECK <br />OTHER <br />REASON <br />--'— <br />STATE BUILDING SURCHARGE <br />tom.y <br />'UBur WORKS <br />INTAKE BY PLANS APPROVEDBY CITY OF EVERETT <br />LOCAL SALES <br />DATE TAX CODE IS31IS 3105 <br />TOTAL <br />a <br />