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APPLICATIG d FOR CONSTRUCI.ON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />F—HEM7ING SYSTEM: ❑ GAS O ELECTRIC U _ <br />BUILDING DEPARTMENT <br />259-8810 <br />I nCRAnI ITIl1M rl CETMRINATIO <br />N I 1 BUILDING IMECHANICAL PLUMBING SIGN <br />j TENANT <br />1 ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />w. <br />(T ­ <br />...___ <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CRY <br />ZIP <br />PHONE STATE LICENSER <br />MECHANICAL CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE IF <br />5/�0,�1,c2.1- isgfto <br />­11—- v I I •. ren AnnM -1 OFOATN f'. nFMOLITION I_l WOODSTOVE/FRPL INSERT i. 1 BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF'- - <br />DESCRIBE WppKAND SQUARE FOOTAGE INVOLVED <br />YNIJ� <br />PROPOSEDUSE qNWFLDNG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />GE �+ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTKNi OF PROPERTY JSHOWN BELOW OR ATTACH FOUR CO�ESI <br />LOT BLOCK OF <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 CWND 296.200 WAC. <br />PRCIECTADDR/qESS iA - <br />SiD11A111FE MtE <br />O e_� <br />frtV ei5MFfi5t¢EHSF 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 />NC—MHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS--B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW P13EVENTERS <br />D <br />GAS PIPING <br />i <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />i <br />i <br />SUBTOTAL $ <br />9 ; — <br />SUB TOTAL $ <br />PERMIT $ <br />IJ ' <br />PERMIT $ <br />TOTAL FEE $ <br />' _ <br />TOTAL FEE $ <br />.- ..cv .Yw V. *w7711/1 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDESETBACK <br />PLAN CHECK U BER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT 6ITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />GCTGPAYCY <br />GRWP <br />xG M mmLMG VFin <br />SIZE OF BLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />_ <br />OCCUPANCY LOAD FIRE SPANKIERS REDO HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />-� <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED By <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />