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Ter <br />z H Lo <br />H O In. <br />cn <br />'w v <br />1 I_� <br />APPLICATION FOR CONSTRUCTION PERMIT L <br />erEvspee TO BE COMPLETED IN INK —PLEASE PRINT <br />CIT <br />JLJL <br />everen HEATING SYSTEM: J GAS ZIELECTRIC <br />BUILDING DEPARTMENT <br />259.8810 <br />: DEMOLITION COMBINATION <br />OWNER MAIL ADDRESS ,, I <br />BUILDING <br />PIIDNF lItAJ - <br />SIGN <br />AaCHRECT OR K;NER <br />MALL ADOHCSS <br />CITY <br />ZIP <br />PHONE <br />- <br />GENERALCWRUICTOR <br />WLL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE If <br />MECHANICAL CONTRACTOR <br />er,00NifG�LdLI9 <br />MAIL ADDRESS <br />1yY✓ oa.J� <br />CITY <br />rs ss<�Oil�_9�/9� <br />ZIP <br />PHONE <br />BZz903o <br />PHONE <br />LICENSED <br />Y,rx°1T�.1 <br />LICENSE• <br />CLAss of womc I ., m I,.11m ITInM - wnnnSTOVr1FRPLINSEFIT BUILDING RELOCATION <br />NtW P.UUIIIVIv - """ <br />caNT EasoNANDJ"� No <br />CONTRACT PaILE OF W <br />DESCRIBE WORT( AND SQUARE FOOTAGE fNVOLVED <br />S—AfJ �1 <br />.' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY)SHOWN BELOW OR ATTACH FOUR COPIES) <br />OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK <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 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 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR A D AGE! <br />X <br />.� <br />PROJECT ADDRESS <br />AP CRY BUSSE NO ANp BUSWESB NAME <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />FEE <br />IkCHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.LU. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />—i,_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE B CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR. ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE S <br />rum vrrn A,a wJG <br />FRONT SETBACK <br />VLVI <br />REAR SETBACK <br />-SETBACK <br />PLAN CHECK NUMBER <br />d,IOFEES <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />VALUATION <br />FEE <br />BUILDING <br />iY'PE OT COMB ALLOWA9LE <br />V_AJ <br />TYPE OF CORSI ACTUAL <br />occl%IxY <br />xo u PMILAL WIS <br />PLUMBING <br />6 4- <br />MECHANICAL <br />SIZE OF BLDG. <br />NO, OF STORIES <br />BASEMENT. <br />IIW�A <br />ADDITIONAL PUN CHECK <br />noCCUPANCYLOM j FIRESPRNKLERBRE00 NEIONi (IMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILO!NO SURCHARGE <br />MTAKE BY <br />PLANS ArPRovEDer <br />JM 1Q <br />CITY OF EVERETT <br />TAX CODE IS ES3105 <br />PUBLIC WORKS <br />TOTAL <br />f <br />