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APPLICAT146 .:'OR CONSTRUCTI%.T.4 PERMIT `'�`T`'" <br />TO BE COMPLETED IN INK -PLEASE PRINT ue <br />iM! Evergreen <br />CITY OF <br />everett HEATING SYSTEM IJ GAS O ELECTRIC ❑ -- --- - 1 <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />O�WpNFR MAIL ADDRESS CITY ZIP PHONE <br />L12��r�dt� �x� /V f b E zlq ay <br />/}��►�][� !!AII AUDRESS CITY I ZIP PHONE <br />ENAH�C — <br />L <br />CITY 21P PHONE <br />ARCHITEC OR DE�ERIAIL/DDRESS <br />FENERAL NTRALTOR MAIL ADDRESS,1,, CITY P PHONE 1 LICENSE( ,Qslos <br />AI/ `- ve <br />CALC RACTOR MAIL ADDRESS CITY Z1p PHONE IICENSEF <br />21P PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY <br />CLASS OF WORK ,r,nu wnnnSTOVETFRPL INSERT BUILDING RELOCATION <br />NEW ADDITION ALTEHAI IUry ncrnu. .._••• <br />-.__ - <br />CONTACT PERSON AND PHONE NO <br />w <br />CONTRACT PRICE OF WORK `� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />EXD9- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSEDUSEOFBUIIDING <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 />IEGAI DESCRIPTION OF PROPERTY ISI!OWN BELOW OR ATTACH FOUR COPIES( <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 />PERFORMANCE OF CONSTRUCTION. THAT 1 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 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />AffCANTS <br />PROTECT ADDRESS f� <br />ICE <br />KO -7- Pt � 3 <br />Y BUSINESS LCENSE NO. AND BUSINESS NAME <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />PLI"B" <br />HO• <br />ABC-ArHNDLG UNITS-H.P. <br />WATER CLOSET (TOILET) <br />FORCED AIRS STEMS -BTU M E.A. <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />�— <br />KITCHEN SINK 8 DISP <br />RANGE HOOD <br />DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY <br />WOOD STOVE <br />' <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />R DRAIN <br />LOW PREVENTERS <br />DRAINS-RAINLEADERS <br />SERVICE -BAR, ETC.) <br />fiR <br />SUB TOTAL $ <br />S <br />PERMIT $ <br />y <br />METAL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />PERMIT $ <br />70TAl FEE 8 <br />' <br />; <br />T <br />0 - <br />'— <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />LOTAREA <br />USEZONE <br />TYPE OT CONTS ALLOWABLE <br />TYPE Of CONST ACI <br />Sn:E OF BLDG <br />NO OF STORIES <br />..-�.......�a nm <br />FIRE SPRNKLEW <br />INTAKE BY I PI AN <br />SIDE SETBACK <br />BUILDING <br />U <br />xco"Mc, No n OAG UWIS <br />IX <br />PLUMBING <br />BSEMENT <br />MECHANICAL <br />9 G3S'' 00 <br />i <br />ADDITIONAL PLAN CHECK <br />HEIGHT (IMITATION <br />OTHER <br />STATE BUILDING SURCHAR%.. <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />9 L 3 r e u <br />