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APPLICATION <br />FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />0 DEMOLITION <br />CI COMBINATION <br />F1 BUILDING Cl MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER <br />MAILA�DDDDDREESS,,�.,�� <br />ZIP P^PHONE� <br />C, , <br />�� Q� <br />,CIIITYY' y-Lnr ^ ( � <br />zy <br />TENANT� <br />MARESS <br />CITY ZIP PHONE <br />� <br />ARCHITECT OR DESIGNER <br />r F¢; <br />MAIL ADDRESS <br />V <br />CITY ZIP PHONE <br />GENERAL C TRACTOR <br />MAIL ADDRESS <br />ZIP PHONE STATE LICENSE # <br />. �_ t&" <br />Cam$ W-I�S c�.e���_ <br />Cam- R Sao3 a5 �'1ls.vok; Zt� <br />MECHANICAL CONTRACTO <br />MAIL ADDRESS <br />CITY ZIP PHONE STATE LICENSE # <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE. STATE LICENSE # <br />CONTRACT PRICE OF WORK <br />5c�o. vd %40 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />14 Q <br />a t -t <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 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK of <br />G� <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS o% \/ <br />501 o . S� S� <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <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 />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />i <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK jJUMBER/ <br />/a -7 <br />C,-%)��-J/ ( <br />FE� i <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO. <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />- <br />TYPE OF CONST <br />NO. OF STORIES <br />OCCUPANCY <br />GROUP <br />NO, OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RECFD <br />BASEMENT <br />❑ YES' ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />I <br />L <br />