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APPLICATICC FOR CONSTRUCAJN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT �w <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS 4ELECTRIC 0 <br />259-8810 <br />DEMOLITION ! i COMBINATION i_ I BUILDING MECHANICAL LI PLUMBING SIGN <br />OWNER MAR ADDRESS /� CITY ZIP PHONE OZr.>�o p <br />C.-i r•a_T .Y ,,A Jo^ Q �a -a.. ,- L —"I_ ... AGI.... �._. l5O <br />//Z/`-,;z /-V <br />I 1 NEW I ADDICON XALTERATION I i REPAIR i I DEMOLITION i I WOODSTOVEIFRPL INSERT ! BUILDING RELOCATION <br />00 <br />CONTRACT PRICE Of WORN <br />%i(�v <br />CONTACT PERSO-1/LAND PHONE M1Vj/�� o <br />(�E� / /LEI . <br />OES flIBE VAAIN AND SWARE FG ITAGE INVOLVED / <br />3 <br />'j /T /O 73 <br />PROPOSED USE Oi BUMWO <br />yJ — <br />— /Lj <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 I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS M E AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW7 RCW AND 296,200 WAC. <br />�// <br />UE DESCNIPTKINOFPROPEWYISI BELOYIORARACHFWRCOPIESI <br />tar BLOCK o< <br />PCiAODR�B <br />E& <br />�/ <br />3 S/ 7 <br />LT'PVSH <br />99 LCENSf M <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPEOF FIXTUREOR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—AIHNDLG 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 B 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 & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK ISERVICE—BAR. ETC.) <br />_ <br />SUBTOTAL <br />$ <br />SUBTOTAL S <br />PERMIT <br />$ <br />PERMIT <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />/n91! — <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REARSETBACS <br />SIDESETBACK <br />PUN CHECK NUMBER <br />FEE <br />RECEIPTNO. <br />USE ZONE <br />LOTAREA <br />VACART WK <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />UK OF CENTS.&UMMILE <br />TYPE OF CONST M3Ul1 <br />M1IIwM AP apHUNilfirts <br />cwn - <br />SIZE a BLOC <br />NO.OFSTOMES <br />DASEMENT <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />OCCNPANCYLOAD FIRE SPRNKLERS REDO HEIGHTITATM <br />REASONFDRSPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />(NUKE BY <br />"IS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />