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Y ' 3, <br />APPLICATIO.. FOR CONSTRUCT►JN PERMIT I' <br />0lf it <br />TO BE COMPLETED IN INK —PLEASE PRINT Illl P,e Ermg,een <br />CITY OF <br />everett <br />BUILDING DEPAPITMENT <br />259-8810 <br />LJ DEMOLITION C'. COMBINATION <br />MAIL <br />HEATINGSYSTEM: ❑GAS ❑ELECTRIC <br />BUILDING <br />❑ MECHANICAL <br />m <br />_j SIGN <br />Wx,1 <br />Zry PHONE LICENSE <br />MECHANICAL CQITRACT011 YA0. ADDRESS <br />MAh ADDRESS CRY ZIP PHONE LICENSER <br />PEUMBNGCON7RACTON <br />Goss OF WdM�,I -- <br />NEW Y4 ADDITION ❑ ALTERATION REPAIR i :DEMOLITION '. AND <br />ONE NO JFRPUNSERT BUILDING RELOCATION <br />coNrAcr PERSON ANo PHONE No. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />PROPO USE OFBU0.DIN0 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DES RIPTKHI OE PROPERTY ISHOWNBELOW OR ATTACH FOUR <br />COPIES' <br />WORK WILL EllCOMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />2\ 1 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT ---F���- BLOCK dOF <br />AUTHORIT`, TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER S?ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEIJ OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18827 RRC�WQR/AND 296.200 WAC. (�� <br />OR AGENT DATE <br />SIGNATURE OF�nTL <br />Cl.' t/� <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS I ICENSE NO, AND BUSINESS NAME <br />4AC C� A'LtT �J� <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />NO. <br />A/C—AMNDLG UNITS—H.P. <br />' <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />BATHTUB <br />UNIT HEATERS--B.T.U. M <br />; <br />LAVATORY (WASH BASIN) <br />' <br />CLOTHES DRYERS <br />SHOWER <br />b 'J37J <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />RANGE HOOD <br />' <br />DISHWASHER <br />) <br />ATER HEATER <br />W <br />LAUNDRY TRAY <br />WOOD STOVE <br />CLOTHESWASHER , <br />I <br />METAL FIREPLACES CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />; <br />DRINKING FOUNTAIN <br />I <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />) <br />BACKFLOW PREVENTERS <br />EXHAUSTFAN <br />ROOF DRAINS—PAINLEADERS <br />SINK (SERVICE —BAR, ETC.) <br />' <br />' <br />I <br />' <br />SUB TOTAL $ <br />SUB TOTAL <br />$ <br />PERMIT $ <br />PERMIT <br />$ <br />TOTALFEE $ <br />U' <br />TOTAL FEE <br />$ <br />FOR OFFICE USE ONLY: RECEIPT NO <br />PLAN CHECK NUMBER FEE <br />FRONT SETBACK REAR SETBACK SIDE SETBACK •�, � _3 / <br />vecANT SITE FEES VALUATION FEE <br />IICP)GNF ILOTAREA I , <br />SIZE OF BLDG. <br />OCCUPANCY LOAD <br />INTAKE BY <br />BUILDING <br />ACTUAL <br />ES <br />dxNo MNALLM MITT <br />^ <br />BASEMENT <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />ERSREOD <br />HEIGHTIUMITATKIN <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />)vED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOEIS 31n51 <br />TOTAL <br />