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APPLICATIOW FOR CONSTRUCT�JN PERMIT FZ <br />the EYe/yrePR TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />eve rett HEATING SYSTEM: CI GAS O ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING_ MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />012 jCAeA)Le,/ iA►17 Fe &tt ua,?-14 `9,D 1 S's9•c�A% <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOH MAIL ADDRESS CITY ZIP PHONE LICENSE <br />cj L 1""o <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEA <br />CLASS OF WORK <br />i NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />�s1T�L Rle CIA, I, <br />PROPOSFD USE OF BUILDING <br />C% r, F, <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 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 />CONTRACT W 18.27 RCW AND 296.200 WAC. <br />SIGNATURE CONT ACTOR OR AUTHORIZED AGENT DATE <br />X � <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LGI BLOCK _ OF _ <br />'--- <br />-----. <br />Sil a <br />APPLICANTS CITY BUSINESS LICENSE NO. AND S INESS NAME <br />PLUMBING <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 />; <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 & DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />d ; �-- <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />� <br />i <br />Vt <br />SUBTOTAL <br />$ <br />SUB TOTAL $ <br />30 <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />,30 <br />FOR OFFICE USE ONLY: <br />FRONT SETBAC• <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUM3ER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />INGUNITS <br />PLUMBING <br />saouv <br />SIZE OF BLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />' — <br />U <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT UMITAi ION <br />OTHER <br />T <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />I <br />- <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />3 0 <br />