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APPLICATIO. _ FOR CONSTRUCTN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />r^� 1 HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL XkUMBING SIGN <br />OWNER MAIL ADDRESS Sf_ • t c nzip <br />llr OQHONE 9Cti _�73/ <br />MAIL ADDRESS <br />DITY 21P PHONE <br />TENANT <br />^n <br />(}(�jnwNti <br />ZIP PHONE <br />ARCHITECT OR DEGIGNER <br />MAIL ADDRESS <br />CITY <br />rf-. 4R'E <br />w s• <br />291 N4.w! Tj <br />(4­� <br />ZIP PHONE STATE LICENSER <br />GENERAL CONTRACTOR <br />MAIL AODRE55 <br />CITY <br />MoRS�c iSo99 c. <br />sAm� a <br />pWYU`LI� <br />ZIP PHONE STATE LICENSER <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />PLUMBING CONTRACTOR MAIL ADDRESS PfITY ZIP PHONE STATE LICENSER o1 <br />5wOR15� (3 <br />P��m1N('' (y/j 22"�51 u`y f orloRNwR. 9Q,cclCSuugS/6Yo� <br />CLASS OF WORK WnnnSTnVFIFRPI. INSERT BUILDING RELOCATION <br />NEW ADDITION /ALTERAIIUN <br />•- <br />------ <br />O <br />CONTACT PERSON ANDPHONE NO <br />� /-i• W14l (- <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND EFOOTAGE INVOLVED <br />l �2� <br />gqW��••ryry2-3�-0331 <br />PTO �"1-1G.vI�SDN ti-I I(Z <br />lSQUARE <br />N� <br />G i�F O�r �" ��L j� ��IS I <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDMG <br />I HEREBY <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />n nT <br />(� FT 1" / <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTVISHOWN BELOWOR ATTACH FOURCOPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 />O ` <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PLRFORM 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 />got <br />PROJECT AOORESS � <br />sy;� 5���- = �L)4%.rr <br />CITY BUSINESS <br />I.CENSENO <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />AC-AIHNDLG UNITS-H.P. <br />( WATER CLOSET (TOILET) <br />5 � - <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />( BATHTUB _ <br />LAVATORY (WASH BASIN) <br />- <br />B.T.U. <br />UNIT HEATERSM <br />I <br />CLOTHES DRYERS <br />—'— <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK & DISP - <br />RANGE HOOD <br />DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />-� <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />' <br />BACKFLOW PREVENTERS <br />EXHAUST FAN <br />' <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR. ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USEZONE <br />LOT AREA <br />TYPE Of CONTS. ALLOWABLE <br />TYPE Of CONST ACTUAL <br />SIZE OF BLDG. <br />NO. OF STORIES <br />OCCUPANCY LOAD <br />FI RE SPRNKLERS REO'D <br />REASON FOR SPRINKLERS <br />INTAKE By I PLANSAPPROVEDBY <br />PLAN <br />BUILDING <br />KCVPAMCl <br />NO DFMILIMLUVPS <br />GRNP <br />PLUMBING <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />HEIGHT LIMITATION <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />1 TOTAL <br />