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APPLICATIC 'FOR CONSTRUCT" 'IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 41-rr <br />ED <br />HEATING SYSTEM: R GAS <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION I COMBINATION 11 BUILDING <br />❑ ELECTRIC ❑ __ <br />YIMECHANICAL II PLUMBING <br />J <br />yLl!'7,1 <br />SIGN <br />I ER MAIL ADDRESS CITY <br />/TLNAIIT <br />ZIP <br />PHONE <br />gas <br />y_ <br />TLNA <br />MAIL ADDRESS CITY <br />ZIP <br />PHONi <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE I <br />MECNANICAI CONTRA TOR <br />_ s <br />/Lu1n i{na <br />MAIL ADDRESS CITY ZIP <br />qq <br />(ed9 $ e /fyc. h�G d'�)o <br />PHONE <br />l3%G99/ <br />STATE LICENSE A <br />/idNET/I <br />G <br />U7!r L <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CRY <br />71P <br />PHONE <br />STATE LICENSER <br />rONTRACT PR;;[ WORN lig <br />•�z <br />Gov. <br />DESCRIBE WORK AND SQUARE F00 .GE INVOLVED <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 />ROPUSFD USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY , SHOWN BELOW OR ATTACH TWO COPIER) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOt BLOCK - OF <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 />— <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT 1ACTOP,S LAW 18.27 RCW AND 296.200 WAC. <br />_ <br />PARCEL TAX I D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS TELEPHONE NUMBER <br />sICNA1uNL "AN <br />_ <br />PROJECT ADDRESS C <br />' lQ��� <br />CITY BU5MFS5 tCFNSF 1q <br />� C <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 />I <br />A,C-AIHNDLG UNITS-H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />�_, <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />i <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />�- <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />SINK ISERVICE-BAR, ETC.) <br />GAS1-- <br />I <br />- <br />I <br />' <br />I <br />1 <br />SUBTOTAL $ <br />SUBTOTAL $ <br />pO <br />PERMIT $ <br />I <br />PERMIT $ <br />00 <br />TOTAL FEE $ <br />TOTAL FEE $ <br />G <br />REAR SETPAr, <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FF7 <br />RECEIPT NO <br />FRONT SETBACK <br />Esc ZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />❑ YES CJ NO <br />TYFE OF COxsT. <br />No of sraGlEs <br />ocunuGCY <br />Ao noATHNC INRs <br />Gft <br />PLUMBING <br />' <br />SIZE OF BLDO <br />FIRE SPRINKLERS NEOD <br />BASEMENT <br />MECHANICAL <br />— <br />C; YES Ci NO <br />--�-- <br />ADDITIONAL PLAN CHECK <br />i <br />i <br />OCCOPANCY LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />OTHER <br />i <br />T <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />NTAKE BY <br />PLANSAPPROVEDBY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />; <br />DATE <br />