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APPLICATIOC FOR CONSTRUCT))-N PERMIT <br />�3�� TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC <br />259-8810 <br />DEMOLITION COMBINATION I BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />r <br />/ T i ci.,F TS / �-/w I, eat d <br />TENANT / MAIL ADDRESS CITY ZIP PHONE <br />�J PO 3v /(yo /n�5 Sa& .�n� `��/// v�Vd 3/3 <br />ARCH17ECTOR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />{a6C,c Pu ¢znui. <_.-d/e i./119Rie 2i a: -Y o4rf. on..,:._... <br />CONTRACT PRICE OF WO <br />o_o <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />K <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 />_ \� <br />pN <br />PROPOSED USE OF BUILDING <br />( �Y"t r « <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX 10 NUMBER <br />CONSTRUCTION LOAN LENDER ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS <br />L12 05 <br />CRY 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 />AC—AIHNDLG 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 />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <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 />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />�— <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECKUMRLFl <br />(ten'' <br />fEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />TYPE OF CONST. <br />NO, OF STORIES <br />DCWPANCY <br />ND UMLLMGUNITS <br />i <br />GROUP <br />PLUMBING <br />' <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RED <br />BASEMENT <br />MECHANICAL <br />❑ YES Cl NO <br />ADDITIONAL PLAN CHECK <br />-- --- <br />; <br />j <br />OCCUPANCY LOAD <br />FIRE ALARM RED D <br />HEIGHT LIMITATION <br />OTHER <br />i <br />' <br />REASON <br />T <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC: WORKS <br />' <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />