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APPLIC,ATICA FOR CONSTRUCT_ JN PERMIT �+ <br />TO PE COMPLETED IN BLACK INK —PLEASE PRINT w✓esrltt7r <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS J EO G T hIk, J <br />259-8810 <br />DEMOLITION COMBINATION BUILL:R't➢ MECHANICAL PLUMBING SIGN <br />�I <br />MAIL AO;��F <br />C <br />ZEP <br />PHONE <br />[•/L(/'/Y/ <br />1 ZR / / 1 <br />Mete <br />`K <br />�v? <br />/ <br />TENANT <br />MAILADDRESS <br />CRY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PRONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE F <br />CITY <br />STATE LICENSE I <br />CLASS OF WORK <br />NEW I ADDITION %ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />'' 11 <br />CONTRACT PRICE OF WOR�VJI�,Y%fr/K� <br />DESCRIBE WORK AND SOUAPE FOOTAGE INVOLVED <br />i'Pr�DUe <br />CONTACT PERSON AND PHONE <br />PROPOSED USE BUILDING �/� /� �q <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />/it'PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN CR <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 RC/W AND 296.200 WAC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOWNBEL ATTACH FOUR COPIEIB <br />LOT _BLOCK of <br />— <br />rnaECTADugrss <br />-- <br />sa uRE DATE <br />LIry Bl19Mf89.ICENYE Hp <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF E4347MENT FEE <br />A/C—A/HNOLG UNI73—!1.F <br />FORCED AIR SYSTEMS-H.Td4, .A. �! <br />-M <br />NO. <br />TYPE TYPE OF FIXTURE OR ITEM <br />_ <br />FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. <br />' <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK IS DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE. & CHIMNEY <br />�— <br />DRINKING FOUNTAIN _ <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />_ <br />Z <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />_--T_ <br />; <br />I <br />I <br />, <br />SUBTOTAL $ <br />SUBTOTAL $ <br />_ __ PERMIT $ <br />TOTAL FEE $ <br />O <br />PERMIT $ <br />I <br />1 O <br />TOTAL FEE $ <br />30100 <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMNI A <br />n'CEIPTNO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- — <br />- - <br />-- -- i <br />TYPE OF CONTS ALLOWABLE <br />TYPE Ot CONSI ACTUAL <br />oI:CUfu[r <br />rq dwnulxc lnrtE <br />6R011P <br />PLUMBING <br />i <br />i <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REDD <br />HEIGHT LIMITATK)N <br />11BPRINKLER <br />' <br />__. <br />REAUON FOR SPRINKLERS <br />T <br />CITY OF EVERETT <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PL/.NSAPPgOVED BV <br />PUBLIC WORKS <br />� <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />