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APPLICATIC <br />1 FOR CONSTRUCT* <br />IN PERMIT <br />TO BE COMPLETED <br />IN BLACK INK —PLEASE <br />PRINT <br />BUILDING DEPARTMENT <br />__1 <br />HEATING SYSTEM: 1] GAS <br />A -ELECTRIC <br />259.8810 <br />11 DEMOLITION i .I COMBINATION <br />I4430ILDING <br />.e MECHANICAL ;CPCUMBING SIGN <br />OWN R MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />E� rf�ifyy <br />5 tfsr�i igel,9 <br />�r8i- 4 S 9 <br />TENA't MAIL DR%ESS <br />CITY <br />ZIP <br />_ <br />PHONE <br />ARCHITE DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PNON <br />O1i ERALCONTRAC OR MAILADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />PnnHK:wI CON/TN�A�CiOR <br />MAIL ADDRESS <br />CITY ZIP P-H,+ONE �7 <br />STATE LICENSE �— <br />PLUMBING CO� <br />//11 <br />ANNTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE- <br />STATE LICENSE R <br />CONTRACT Plid OF WORK <br />' s Z <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. E <br />zyfoe <br />zpp <br />cg 2 ©.� <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 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 M DE AN 1 COMPLY WITH THE STATE <br />CID TORS LAW 1 27 AC, <br />1 <br />PROPGSED US— BUILpIN T <br />• <br />LEGAL DESCRIP IONOF ISH�TTACH TWO COPIES) <br />Lot BLOCK of <br />rr <br />+� <br />ER <br />2MUM8PAR7 5-k 5 <br />CONSTRUCTION LOAN LENDER.ADDR SS`, TELEPHONE MBEFI <br />JECE ADDRESS <br />r <br />T <br />sroluTl,Rl DATE <br />cn nusmf ss rfrvsnm <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 />A/C—A/HNOLG UNITS—H.P. <br />, <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />; <br />_ <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />_ <br />ROOF DRAINS-RAINLEADERS <br />1 <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />_ <br />I <br />, <br />1 <br />T <br />, <br />I <br />I <br />, <br />, <br />I <br />I <br />SUB TOTAL <br />$ <br />T <br />SUB TOTAL S <br />' <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDS VGIIACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />' <br />' <br />A <br />Z? <br />c/40 <br />USE ZONE <br />LOTAREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />Z- 1 <br />i% <br />PI YES ❑ NO <br />BUILDING <br />I — <br />YPE Of CONST. <br />NO O STORIES <br />D y <br />W UOW UM IIKITF <br />' <br />� _ <br />' <br />PLUMBING <br />, <br />I <br />Gf3 <br />SIZy'O ggI�DG <br />G'�Yo Sf <br />GM( <br />FIRE SPgINKlERSREOD <br />BASEMENT � � <br />MECHANICAL <br />9ni <br />se <br />r'I YES 7YN0 <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE AIARM REO0 <br />HEIGHT LIMITATION <br />A <br />I <br />OTHER <br />Ah ny <br />' <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE 6Y <br />PIANS APPFOVIED BY CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE I TAX CODE IS 3105 <br />TOTAL <br />I <br />Z 9 <br />I <br />