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APPLICATIC FOR CONSTRUCT' )N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: 0 GAS ❑ ELECTRIC U <br />259-8810 <br />❑ DEMOLI T !ON ❑ COMBINATION )<BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE ^ <br />CITY ZIP PHONE <br />MAIL ADDRESS CITY ZIP PHONE <br />GENERALCO9F,MAIL <br />R <br />f ZIP PHONE <br />/I c <br />STATE LICENSE <br />JEC L <br />�CA� 7-/h <br />Au& �� <br />(/CITY <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />ZIP PHONE <br />STATE LICENSE <br /><U Be 5e:_rL-� <br />- <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE.40. <br />I HEREBY CERTIFY TIIAf I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOP, 1HE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF 13UILDING <br />p <br />blG /{ L <br />PROVISIONS OF LAWS AND ORDINANCE3 GOVERNING THIS TYPE OF <br />WORK WILL. BE COMPLEi ED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTIONOFPROPERTY (SHO.VN BELOW OR ATTACH TWO COPIES) <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 W. 9K FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC ORS L VJ 18.27 CW AND 296.200 AC. <br />/ <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER,ADDRESS, TELEPHONENUMBER <br />PROJECT ADDRESS <br />sic RE DATE <br />CITY BUSINESS LICENSE No <br />AV <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <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 />rNO.I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />T— <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />URINAL <br />DRINKING FOLINTAIN <br />FIREPLACE INSERT <br />) <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR. ETC.) <br />I <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />run urrll,C v�Q <br />FRONT SETBACK <br />vF.i,l. <br />REAR BETPADK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />/��%J� <br />FFEpp1LjiEC <br />1I�T NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NU <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST <br />00 au7rturJ�E <br />SIZE OF BLDG. <br />T� <br />NO. OF STORIES <br />00.VMNCv NB BF pWTDINB UNBS <br />GROUP a <br />BASEMENT <br />El YES a NO <br />PLUMBING <br />' <br />FIR iIINKLERS REOD <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />; <br />_ I <br />OCCUPANCY LOAD <br />v <br />FIRE ALA REO'D <br />HEIGHT LIMRATION <br />OTHER <br />_b <br />REASON <br />STATE BUILDING SURCHARGE <br />Z/ o <br />PUBLIC WORKS <br />) <br />INTAKE BY <br />PUNS APPROVED BV <br />Jm <br />DATE Omlla <br />I CITY OF EVERETT <br />LOC;.LSALES <br />TAX coo=- IS 3105 <br />TOTAL <br />1 <br />