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A PPLICA.r' 0N, FOR CONSTRUCTI� IN PERMIT <br />TO I,. --COMPLETED IN INK —PLEASE PRINT <br />Me Evnrgroen <br />CITY Of }} <br />everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8B10 <br />I I DEMOLITION CI COMBINATION U BUILDING 1.1 MECHANICAL ❑ PLUMBING I_I SIGN i <br />A q H <br />�xsHx[n <br />CH3 2 <br />HC C) <br />M <br />"0 <br />x rAH <br />D1 O <br />H t7 <br />H M O <br />ZHR <br />E"HH <br />G rA <br />00Tn <br />PLUMBIK3CONTR/CTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />n ovoAlc n ncAAnl ITInN 11 WOODSTOVE/FRPL INSERT ❑BUILDING RELOCATION <br />u IYcrY u nwniv. ... ..�, �., ...-... ._ .._. <br />..... _. <br />CONT�A�CT PERSON AND PHONE NO. <br />Y" w 4A,4% '2/ S- 3 32- Oir <br />CONTRACTPRICE OF WORK <br />O'7">' <br />,/r� /F <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSE •E OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />THISTYPE OF <br />.L—EGI1AL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING <br />DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR <br />COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT. BLOCK of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 10 GN= <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF •'':`' <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH - L <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY ' ;E <br />OWNER OF THIS PROF ERTY TO PERFORM THE WORK FOR WHICH <br />-- - <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 I UTHORRED AGENT DATE <br />•_ <br />APPLICANTS Y USINESS LICENSE NO.Arv:-1 MANESS NAME <br />PROJECT ADDR—S "' <br />T <br />FE 3Y H� <br />PLUMBING <br />MECHANICAL <br />N(,• TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT_ FEE <br />I— <br />WATER CLOSET (TOILET) <br />I <br />AIC—A/HNDLG UNITS—H.P. <br />' <br />_ <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />) <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />—� <br />DISHWASHER <br />' <br />RANr_HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />) <br />I <br />_ <br />CLOTHESWASHER <br />WOOD STOVE <br />' <br />_ <br />URINAL <br />' <br />METAL FIREPLACE 8 CH EV <br />' <br />_ <br />AIN <br />FIREPLACE INSERT <br />' <br />HEAT PUMP <br />' <br />VENTERS <br />; <br />GAS PIPING <br />RAINL DERS <br />I <br />EXHAUST NB <br />, ETC.) <br />w <br />I <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL <br />A <br />r vn vrA lv., r <br />FRONT SETBACKK <br />_, EA <br />_ REAR —SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />RECEIPT NO. <br />X(Si7tiy_�_ <br />9� Sews ' 1ys�3? <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />UO <br />i <br />I <br />�j <br />C — I � <br />No <br />TYPE OF CONTS. AUOWABL <br />TYPE OF CONST. ACT L <br />auwAxcr x0.gwrtw uxnF <br />cnap, <br />l ALf- I I_ "'VVV <br />' I — <br />ME <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />, ' <br />jGYJ 5Q �fi <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOAD <br />FIRE SPRNKLERS REOU <br />HEIGHT LIMI rATION <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />Cp ! <br />INTAKEBY NERETT <br />Y CILOCA <br />PUBLICWORKS <br />i <br />QP�P°D <br />SALES <br />TAX CODE IS 3105 <br />TOTAL <br />p <br />:1 <br />