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APPLICATIOb.d FOR CONSTRUCTIjN PERMIT F <br />1 <br />TO BE COMPLETED IN INK —PLEASE PRINT F <br />Iho EYerRteen <br />CITY OF <br />eve rett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O _ <br />BUILDING DEPARTMENT -- -- <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP P NE <br />7 Bos��►c Go. Wax 10� h S OP—X IlEse,+ f✓�¢. 9YkII( <br />TENANT MALApDRE55 CITY ZIP PHONE <br />NIIG *:F o AJNIvN <br />ARCHIiGT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />T a+rsrw co <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE /icl r/lr <br />�77 <br />SA-ni'1� A�S <br />r42c.uTa,r�l' <br />/io�r- <br />c <br />/7 �..,., w <br />�....z �r .?a�- <br />�.7 2-Eecv1 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />X NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CON'AC-I `PERSON AHDPTHGNE <br />"�'E• TLSM6sAf <br />DESCRIBE RK AND SQUARE FOOTAGE IgVOI D <br />D Li n� Q AIM Ny jt 0 K IT <br />PROPOSEDUSEOFBUILOING <br />— — <br />I HEREBY CERTIFY THAT 1 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 LIN 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 RION AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />9/i(. , <br />APPLICANTSCITY BUSINESS LILfiNSE NO AND BUSINESS NAME <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BEIJW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />— <br />PROJECT ADDRESS r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF-GUIPMENT <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.P. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <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 />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />p <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 />RECCIPTNO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />�OlJl.l DnTlp <br />TYPE Of CONIS LOWABLE <br />TYPE OE LO�NST/�t TOAL <br />xA�[wAx[r <br />xo M VAH,%.uN is <br />- <br />- <br />_ <br />' I _ " V <br />° <br />PLUMBING <br />; <br />SI .OF BLOC <br />NO Of STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REDD HEIGHT LIMITATKIH <br />OTHER <br />REASON FOR SPRINKLERS <br />—}-- <br />--- <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS PPTIOVEDOY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />y <br />yl <br />l <br />TAX CODE IS 3105 <br />TOTAL <br />