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APPLICATII FOR CONSTRUC"I'SN PERMIT everett <br />mP E..+vrePR TO BE COMPLETED IN INK —PLEASE PRINTue <br />c1 Yof <br />everett HEATING STEM: ❑ GAS YS❑ ELECTRIC ❑ <br />BUILDING UEVARTMENT —'— <br />259-8810 <br />DEMOLITION COMBINATION 7C BUILDING MECHANICAL PLUMBING SKIN <br />OWNFP 4+i ALlN^ [5'i CItY IIP PHONf <br />r,1.1.�-r,B.I.cc-�.ra-c i�,v ,C..,.�n FJrrvT• 4XaLo� a s � - 3`/09 <br />M+i AOOPE!S <br />gIMBM LONIPKLOR MAT,ADD9ESS CIT' SIP PHONE LICLNY- <br />, u.c a nF.Hl nFMOI ITIOBI WOODSTOVETRPL INSERT BUILDING RELOCATION <br />''TR EOfWORK a35ooi0 i71�/G <br />fONiAti SCN AHD PNCNEM <br />//a✓c� �J� a-YLP'Y4J'� <br />DEsr1R vAJRK AND sou+REFmT"cE NvavcO <br />e �RKA1Nb�lk/ALL. .}SA ��,°Al�r <br />P. 7y BuioN <br />�(Jg <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 10 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 296200 WAC. <br />SIGNATURE DE EEATRACTOR OR AUTHORIZED AGENT DATE <br />APR(CANTSCITV OU91NM tICENSE W ANOBUSNESS NAME <br />LEGAL DESCR'PTGN OF PROPERTY ISNOBN BELON DRA 1-5.Im. COETSI <br />LOT d YBLOCK ,� a -o +- -OL <br />V C <br />PROJECT ADDRESS <br />3Q,o/ OV_ li.c )LAC <br />�M1 �i--//'"'N L, <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXYURE OR ITEM <br />FEE <br />NO. I <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />KC-AMNDLG UNITS-H P <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T U. M E.A. <br />LAVATORY (WASH BASIN( <br />UNIT HEATERS -BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />SUBTOTAL f <br />SUBTOTAL f <br />_ <br />_ <br />PERMIT f <br />q <br />PERMIT f <br />TOTAL FEE f <br />TOTALFEE f <br />cne ncelre I I= nul V. <br />f ROOT SETBACK <br />REAR YIBACK <br />SOE SETBACK <br />PLAN CHECK NUMBER <br />f[F <br />RECEIP11q <br />USE IONE <br />LOT AREA <br />VACANT SIR <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />Dp <br />G u <br />TYR DI COALS AILMABLF <br />"OFONTIMLU.LL <br />DSN%Y <br />.00MILKc6'nR <br />SIZE OFBLDG <br />NO ff STORMS <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />OCCUMNLYLOAO FIRE SPRNKLERS REM WIGHTLARTATUN <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />NTAKE BE <br />PLANS APPROVED BY <br />CITY OF EYERETT <br />LOCAL SALES <br />TAX "0DE IS 3105 <br />PUBLICWORKS <br />TOTAL <br />G <br />