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APPLICATIO <br />FOR CONSTRUCTr <br />'N <br />PERMIT <br />4:1rr <br />TO BE COMPLETED <br />IN BLACK INK —PLEASE PRINT <br />HEATINGSYSTEM: UGAS ❑ELECTRIC <br />U <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />f I BUILDING ❑ MECHANICAL <br />boLPLUMBING ❑ SIGN <br />OVR(ER ./I_ .MAIL ADDRESS <br />CITY ZIP <br />Qi�bTStS,�i <br />PHONE <br />�Z03 '�3-191 <br />L IICIVie 4 IVyy&sc b-I}z <br />II/I �JPVLfi <br />11iA <br />TENANT MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY ZIo <br />PHONE <br />GE NEFFAq CONTRACTOR MAIL ADDRESS <br />�MAIL <br />CITY ZIP <br />PHONE <br />STATE LICENSE F <br />MECHHAANNICAALLCONTRACTOR ADDRESS <br />CRY ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADORESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE F <br />CON CT PR7 ICE F WORK <br />l e .3. ba -z <br />DESCRIBE WORK AND SWARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />oY Lv5 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF IR DING <br />`ILn L gI TPlil' <br />F <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGALDE IPTKNIOFPROPERTY(SIIOWNBEIOWORATTACNTWOCOPIE51 <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 />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAXI D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />S of 0" <br />CIFY9USMFSSLWJ"FIq <br />1 I a <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/HNDLG UNITS-H.P. <br />' <br />BATHTUB <br />; - <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I -' <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />_T <br />DISHWASHER <br />RANGE HOOD_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />MEIAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />' <br />SUB TOTAL <br />$ <br />; <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />run urrTva vac- <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECK"RFEE <br />RECEIPTNO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FLUATION <br />FEE <br />BUILDINGTYPE <br />❑ YES ❑ NO <br />OF CONST <br />NO OF STORIES <br />ott~Y <br />Ko V UMLLnq UTAS4R01PPLUMBINGSIZE <br />MECHANIC <br />' <br />OF BLDG <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />!:7 YES [I NO <br />- <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE ALARM REDD <br />HEIGHT LIMITATION <br />OTHER <br />I <br />I <br />_ � F Z� <br />REASON <br />STATE BUILDING SURCHARGE <br />—� <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVLD Ov <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />3 <br />