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� everts[ <br />APPLICATIOI. FOR CONSTRUCTIvN PERMIT <br />the Emrgr"n TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: 0 GAS ❑ELECTRIC ❑ <br />DEPARTMENT <br />BUILDING <br />259-BB . 0 <br />DEMOLITION rOMBINATION <br />OVINER MA._ ADDRESS <br />' BUILDING i 1 MECHANICAL <br />L] PLUMBING i SIGN <br />y 3Vr _ s d'ij' <br />TENANT MAIL ADDRESS CITY ZIP rn�nc <br />'c <br />ARCHITECT OR DESIGNER MAIL ADDRESS w/ CITY ZIP PRONE <br />r'r 4V <br />niY ZIP PHONE LICENSER <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CRY <br />rntJnc <br />I <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK --I .7 ^.1 n REPAIR 1-1 nFM01 ITION WOODSTOVE/FRPL INSERT G BUILDING RELOCATION <br />,v ncn nvw.. Lo. ........,....... _. .._...... <br />---T <br />CONTACT PERSON AND PHONE NO <br />M <br />L �'' .,• r<? •lam • .-/i�'C7 /'S•C /• C `/ ''( f _ <br />CONTRACT PRICE OF WORK /� C7OJ <br />pEWTIEWORK AND SOIFARE FOOTAGE INVOLVED r <br />. /— <br />JU�/„1:. ;� i32 rll` FAA-Tj.JG r.•, — <br />----- --- -- <br />PROPOSED USE OF BUILDING <br />1 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 />LEUAL DESCRIPTION OF PROPERTY IBFgwN BELOW OR ATTACH FOUR COPIESI <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 />- — <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />rr <br />PROJECT ADDRESS <br />_ <br />APPLICANtS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <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 />_ <br />LAUNDRY TRAY <br />WATE9 HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <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 />;_- <br />SINK (SERVICE -BAR, ETC.) <br />1 <br />I <br />I <br />SUBTOTAL $ <br />SUB TOTAL _$ <br />' <br />PERMIT $ <br />PERMIT <br />TOTAL FEE $1 <br />TOTAL FEE E <br />' <br />rvn vrr.va. vvr <br />v -.. <br />FEE <br />RECEIPT NO <br />FRONT SETBACK <br />HEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />�t <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />7 5 aA <br />9y a o� <br />I <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CONSt ACTUAL <br />IlCcuvgtr <br />xn aow[wNG umis <br />v <br />";° <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />COv <br />ADDITIONAL PLAN CHECK <br />OCCUPNa LOAD fIgE SPRNKICRSRC00 UEIGNTIIMITATl011 <br />_— <br />�E5c <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE BY <br />PLA PROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />�y yo <br />