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APPLICATI( I FOR CONSTRUC7 3N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: 1 GAS J ELECTRIC ir— upsiE.. . <br />259-8B10 <br />DEMOLITION COMBINATION BUILDING ✓MECHANICAL PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />somet CO. <br />em <br />3W7 MS OF ,'a SeA,_9B1Z4 <br />342 <br />sM <br />TENANT <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE t <br />JHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE It <br />lid <br />k)r. fkj <br />MW 2 67 orA q8 767•SOQS <br />"6rvt 1zL ar <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />C ZIP <br />PHONE <br />STATE LICENSE <br />CLASS OF WORK <br />.IcTM ./AFIPITInM AT Tl_RATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />Z `6mj4L:MS <br />CONTACT PE RSON AND PHONE NO <br />- <br />D <br />DESCRIBE WO'IK AND SQUARE FOOTAGE NV(I <br />S1�u—LLpCfIQA1_%y1�A(dSt f&r. GIG <br />CROP SED1 OFBUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK OF <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 />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 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 RRCW AND 296.200 WAC. <br />X <br />7 Y — �� <br />PROJECT ADDRESS <br />_ <br />• <br />SGNAT <br />CHYBuSINE%IICFNSF NO <br />PLUMBING <br />- <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 />AC—AHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATILIN FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE._ <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />o ' <br />PERMIT <br />$ <br />PERMIT $ <br />T <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONIS ALLOWABLE <br />TYPE Of CONSI ACTUAL <br />aIaa> u pll <br />10 a 11146 a 111 <br />PLUMBING <br />i <br />MECHANICAL <br />SIZE OF BLDG <br />NO OF STORIES <br />EASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY lOAD FIRE SPRNKlERS REDO HEIGIIi LIMITATION <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BV <br />TPLWANSOVEDBY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />