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APPLICATIC I FOR CONSTRUCT�)N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />OWNER <br />HEATING SYSTEM: J GAS ] ELECTRIC U <br />COMBINATION <br />4-.f <br />BUILDING 1 I MECHANICAL PLUMBING SIGN <br />PHONE <br />nr. r <br />rnmT nuuncaa <br />CITY <br />ZIP <br />PHONE <br />�- <br />ARCHITECiORDESIGNER <br />�. <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />c a <br />G <br />J.r erz yefl <br />HONE <br />STATE LICENSE <br />GEAL COiAC.O;"o <br />MAILsSS%.�aas <br />CITY <br />r-e <br />4a, iI�EI r� <br />mw ����f„ <br />9? <br />y <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />ZIP PHONE STATE <br />CONTRACT PRICE WORK <br />50 (� <br />DESCRIBE WORK AND SQUARE OOTAGE 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 />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 />.may, <br />�dALL /�J FYI <br />PROPOSED U) ; UILD LG . <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWOCOPIES) <br />LOi BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />C-�TR^UCTION l LEN ER. ADDRES T EPH <br />�/ <br />E NU <br />ROJECT AJJD RES <br />�T <br />�'�may- <br />s1LTURE R.TE <br />COY BOSM[55I ICENSE 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 />AIC-AMNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL S <br />_ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />env A/Aa , Oiorlr _%ep <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH CKNU ER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES C NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />Q <br />, <br />' <br />TYPE OF LONSi <br />XII - I fi►� <br />j0 QF STORIES <br />iSL�H <br />a r <br />=UONNCr <br />GRDUP <br />Ism <br />HO IN UWFLuxG UNITS <br />SIZE OF BLDG <br />FIRE SPRINKLERS REO'D <br />NO <br />BASEKENT <br />❑ YESNO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />, <br />OCCUPANCY LOAD <br />3/ 71. <br />FIRE ALARM RED <br />AM <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />44 <br />DATE �3 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />1 <br />~— <br />TOTAL <br />93 '70 <br />