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APPLICATION FOR CONSTRUCTIO'1 PERMIT <br />TO BE COMFLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMFNT HEATING SYSTEM: U GAS U ELECTRIC U <br />259-8810 <br />LI DEMOLITION I I COMBINATION I BUILDING ❑ MECHANICAL CI PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />/Y,>Llf� �72� cEoarz C.vc=lzt r Z ;��� �2S9-6o1 3 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />—, 49 .T • /Vr' C C' <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE UCEN',L+ <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />11Z IrOl, -7-D ,_-2,4 ,. ram•. <br />CITY ZIP PHONE <br />7 i 2_L. J_5 A u.= Cr- 3;t-/0/ <br />SIAIL LICLNSL <br />✓�0/ L PLT-'ml3l' <br />S/L-113f <br />CONTRACT PRICE OF WORK <br />�% �O o K c� <br />DESCRIBE WORK AND SQUARE FOOTAGE INV LVED <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 TP' IE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER tPECIFIED HEnE N 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 />l <br />X /6, <br />SIGNAIURE <br />CITY ouswcsS l¢Ivsulo <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACII TWO COPIES) <br />Lot BLOCK of <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />z 2,ct <br />PROJECT ADDRESS <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 (-OILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />2 ' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <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 />i <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />v� <br />'4141NKiNfif0tlNNiAIN F/ S/,✓ <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />!_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />lNIG <br />�— <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $1 <br />PERMIT $ <br />; <br />TOTAL FEE $1 <br />TOTAL FEE S <br />I <br />'OR OFFICE USE ONLY: <br />PONT SETBACK <br />REAR SETBACK <br />SIDE. SETBACK <br />PLAN CHEC NUMBER <br />FFi <br />HECFIPT NO <br />ISE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />1 I YES NO <br />BUILDING <br />; <br />YPE OF CDNST <br />NO OF SiORIFS <br />ocNr>YICr W LYPM"H "S <br />PLUMBII IG <br />smp <br />IZE OF BLDG. <br />FIRE SPRINKLERS REO'0 <br />BASEMENT <br />MECHANICAL <br />i <br />I I YES n NO <br />OJ <br />APLAN <br />ADDITIONAL LN CHECK <br />' Y <br />YCCUPANCV LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />OTHER <br />i <br />EASON <br />STATE BUILDING SURCHARGE <br />1TAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC VVORKS <br />LOCAL SALES <br />TOTAL <br />; /,� 7 i <br />DATE <br />TAX CODE IS 3105 <br />