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APPLu1CATIC i FOR CONSTRUCT IN PERMIT <br />TO BE C'O!'PLETED IN BLACK INK —PLEASE PRINT <br />,EATING SYSTEM: ❑ GAS LdELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 �/ <br />❑ DEMOLITION ❑ COMBINATICN ❑ BUILDING IVMECHANICAL ❑PLUMBIWG SIGN <br />1e ZIP PHONE <br />G/EjJERALCONTRACTOR <br />MA{L ADDRESS <br />i Ti <br />!/'FC- <br />CITY ZIP <br />I z*A" Nw -Q C�fss. <br />�3I,—PHOZy� <br />J <br />STATE LICENSE 71 <br />MOX2 <br />L_ldL50T-ci� <br />MECHANICAL CONTRACTOR <br />— yQ <br />PLUMBINGCONTRACTOR <br />MAIL ADDRESS <br />TAIL ADDRESS <br />7 <br />CITY ZIP <br />e <br />CITY ZIP <br />PN NE <br />- <br />PHONE <br />SATE LICENSE# <br />e �kw 12,7 <br />STATE LICENSE <br />CONTRACT PRICE OF WCRK <br />OE. RIB/E.WORK AND SOUARE FOOTAGE INVOLVED�--` <br />CONTACT PERSON AND PHONE NO. -e- /s <br />r7 <br />5„/ w�� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOR THELL BE GRA TANG OF AD ERMIWITH TYDOES NOTPRESUMEHETHER SEFIED EREIN OR <br />GIVE <br />BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOT — <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 />— <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 29E.200 WAC. <br />PARCELTAX I.D. NUMBER <br />CONSTRUCTION LOnN LENCER. ADDRESS. TELEFHONE NUMBER <br />x <br />_ <br />PROJECT ADDRESS <br />SKINAiuRE DATE <br />CIIV BUSWE$S OCENSE NO <br />�^ LO <br />S V t <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />NC—A/HNDLG UNITS—H.P. ' <br />� <br />FORCED AIR SYSTEMS—B.1.U. M E.A. _ <br />BATHTUB <br />' <br />_ <br />UNIT HEATERS—B.T.U. M <br />' <br />LAVATORY (WASH BASIN) <br />' <br />CLOTHES DRYERS <br />SHOWER _ <br />' <br />VENTILATION FAN <br />' <br />KITCHEN SINK 8 DISP <br />_ ' <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE—� <br />URINAL _ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />' <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />' <br />' <br />BACKFLOW PRFVF.NTERS <br />; <br />GAS PIPING <br />-- <br />F§AUdLEADERS <br />ROOF DRAINS— _ <br />, <br />EXHAUST FAN <br />' <br />, <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />— <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />SIDE SETBACK <br />PLAN CHE KNUMBER III <br />RECEIPT No <br />FRONT S",TBAC, REAR SE (SACE <br />^�� ER <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />, <br />USE ZDNE LOT AREA <br />❑ YES ClNO <br />BUII DING <br />' <br />TYPE OF CONST. <br />NO.OF STORIES <br />Occu�"CY <br />GROUP <br />N UMIHLINGUNIT5 <br />PLUMBING <br />' <br />' <br />' <br />MECHANICAL <br />SIZE OF SLOG. <br />FIRE SPRINKLERS REDO <br />BASEMENT <br />❑ YES ❑ NO <br />i <br />ADDITIONAL PLAN CHECK <br />' <br />_ <br />OCCUPANCYLOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />' <br />' <br />REASON <br />PUBLIC WORKS <br />I— <br />' <br />INTAKE BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />; <br />1 <br />LOCAL SALES <br />"I <br />TAX CODE IS 3105 <br />TOTAL <br />DATE ��1;r, <br />