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APPLICATIC i FOR CONSTRUCT,, JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC p <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL #,PLUMBING I SIGN <br />OWN R "IT AODR Ell CITY ZIP PHONE <br />rdi f fAtO&I�i. li1]. �rr.Kt <br />TENANT <br />OR DESIGNER <br />CITY <br />CITY <br />,1• rnuN[ <br />ZIP PHONE <br />--••- •..•. mnii wvnoaa CITY ZIP PHONE STATE LCENSE• <br />MECHANIGgI CONTRACTOR MAIL ADDRESS CITY ZIPTn� PHONE STATE LICENSE <br />PLU RING CONTRACTORMAIL ADDRESS 7CITY /1 J/ PHONE �� S�igi�E Lly`CENSE`/ y� <br />C�jS OF WON '- - � '> C_ Q��I t.Z Si� f <br />r NEW ADDITION ALTERATION REPAIR nEMnI ITION <br />10 <br />CONTRACT PRICE OF WORK '\Gi�•eO�` <br />DESCRIBE WORK AND SOLARE FOOT E VED <br />PROPOSED USE ulLDwc <br />&M <br />CONTACT PERSON AND PHONE NO <br />,`�}_� <br />s— <br />I 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 CANCEL THE PROVISIONS OF ANY <br />THER 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 />CONTRA ORS LAW 18.27 RCW AND 296.200 WAC <br />X <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES, <br />LOT_ BLOCK ��--- - - ----- _ <br />TVmw 7 <br />J <br />-. <br />�03 (� / /�--- <br />PROJECT ADDRESS <br />PLUMOM <br />s�cverunl. BqE <br />CnY BIISINFSS UCLNSE NO <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 />A'C-A-HNDLG 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 />---'— <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE B CHIMNEY <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 />�- <br />SINK (SERVICE -BAR. ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />-SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USL ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CONS, ACTUAL <br />acay.Acr <br />r,B u<CALLuSS a+:Is <br />PLUMBING <br />i <br />Barn <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />OCCUPANCY LOAD FIRE SPRNNLERS REOD HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />I <br />/, /7 0 <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />TOTAL <br />TAX CODE IS 3105 <br />