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APPLICATIn <br />FOR CONSTRUCTISN <br />PERMIT <br />PYL'f1'1t <br />The Evcrpceen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />HEATING <br />SYSTEM: U GAS U ELECTRIC <br />�_—_ R� F75L'iFItiCs <br />259-8810 <br />I I DEMOLITION I I COMBINATION <br />--- <br />>? BUILDING I i MECHANICAL <br />I I PLUMBING <br />i I SIGN <br />OIVNER MAIL ADDRESS <br />CITY --- ZIP PHONE <br />lCI� c tH <br />EVMrYL/ <br />ZtW <br />TENANT <br />TENANT MAII.A DRESS <br />F,A/p ZIP PHONE <br />CITY <br />_— <br />LLt7iIECTURGES <br />cSirNED 1Z��_P.o. 1rSc�tE 2noT <br />CVMMTr <br />AIICIIIiECT (Iq DESIGNER MAIL ADISflESS <br />WPt Q1570S 2 -1 <br />CITY —� ZIP PHONE <br />7/ <br />— <br />cNY ZIP <br />PHONE LICENSEA -- <br />*Qw L0_ RJI I - R <br />)'TOR <br />MF.CIIANM.AI CONTRACTOR <br />NOT' /1J_ <br />7Aa14 1 ti vmlt <br />MAIL ADDRESS <br />T ye+city •L WA 9 <br />7�,S�ZSs� 6CLJ1[fJIRYfR <br />CITY ZIP <br />_ <br />PHONE LICENSE) <br />K"n <br />PLUMBINGCONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PIgNE LICENSE/ <br />bLpT Kb& wbl <br />CLASS or WORKY, <br />--— <br />V,T ' <br />I I NEW +./+DDITION <br />kALTERATION <br />I I REPAIR I I nFMnl mnM I <br />I,.,...,.,�..,,,�.�...., <br />— <br />----'_" ' ' ..- I I oUILLU1NUNLLL&A11UN <br />CONTACT PERSON AND PHONE NO <br />CON] DACT PRICE OF WORK fi±rDgW�WE <br />ESCpRK ANSOFOOTAGE NVOL DCGP9CHIOTO t �Oti r 1K r RE]OM. <br />- <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />p/sy -(TMWT OR hJNUTIONAI,_[ <br />- <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />- <br />PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LOF - BLOCK OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />— <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 />PEPFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />-- -- <br />OWIJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />-- <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNAH IRE OF CONTRACTOR OR AUTHONIZED AGENT DATE <br />_ <br />X <br />PROJECTADDDESS <br />ANTS CIT BUSINESS LIC ENO DBUSINESS NAME <br />PLUMBING ; <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C-A/HNDLG UNITS-H.P. <br />' <br />_—_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />--� <br />-- <br />LAVATORY (WASH BASIN) <br />I-- <br />— <br />UNIT HEATERS -B.T.U. M <br />_SHOWER___ <br />.�.— <br />CLOTHES DRYERS <br />--�-- <br />KITCIIENSINKBDISP <br />VENTILATION FAN <br />_DISHWASHER <br />LAUNDRY TRAY <br />_ <br />T— <br />; <br />_ <br />RANGE HOOD--�-- <br />WATER HEATER <br />�- <br />- _ <br />CLOTHE_S WASHER <br />—_-- <br />WOOD STOVE <br />�— <br />_ <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />--- <br />_-_ <br />DRINKING FOUNTAIN _ <br />FIREPLACE INSERT <br />I — <br />_ <br />FLO_OR DRAIN;-- <br />- <br />HEAT PUMP <br />;-- <br />, <br />BACKFLOW_PREVENTERS <br />GAS PIPING <br />I <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />' <br />EXHAUST FAN <br />,— <br />---�--- <br />--- <br />Sl1B TOTAL $ <br />—_ <br />; <br />-- <br />SUB TOTAL $ <br />I <br />PERMIT $ <br />�— <br />PERMIT--y <br />---'�--- <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />run urrlL.E USE ONLY: <br />I DOfI15F (BACK NEAR SEIBAC SIDE SETBACK PI AN f.IIEC NIIMBFR FE �/ RECEIPTNO <br />ZU - ZD S /01 ` 7�O <br />usT Ton ( - for AREA VACANT SITE FEES VALUATION �F/EE/y/ T <br />— (ONI nn _ BIJIL DING �1.p. 0 nd <br />IYI'11lf CBIIIS AIIDWABIF IYI'F DI CBHSI AQUAL W[IMAHp Mn IXpWlllnlA eNl13 <br />z— r 1 rnal� — — —_ <br />ly PLUMBING ; <br />S17F: Or I DO <br />NO Or STORIES <br />BASEMI <br />Ivo� a-DL7 <br />Z <br />-- <br />OF.CII{'ANCY LOAD <br />-t- I+ <br />FIVE PnNKLERSREQ0 'Y: <br />R <br />HEIGHT <br />NFASON I OR SPRIIIKI FRS <br />INTAKE RI— PLANS APPROVED BY CITY OF EVERETT <br />LOCAL SALES <br />----TAX CODE IS 3105 <br />MECHANICAL <br />I ADDI110NAL PLAN CHECK I I ' <br />OTHER <br />I <br />V I _ <br />—_-__ _ C� <br />STATE BUILDING SURCHARGE <br />1� <br />PUBLIC WORKS <br />I <br />TOTALS7 <br />