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1a s <br />APPLICATIO.J FOR CONSTRUCT.JN PERMIT EU <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC 0 <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION COMBINATION Cl BUILDING MECHANICAL SIGN <br />CRY ZIP PHONE .�� '/ / <br />OWNER MAIL ADURE55 sop / F .. S ! // <br />�IrC-n /:�f [n dY/ /Una Cr /.:...-�-��/t✓�/t� <br />CRY <br />ZIP PHONE <br />ounuP LICENSE <br />CLASS OF WORK C; BUILDING RELOCATION <br />❑ NEW ❑ ADDITION 'iP ALTERATION REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT <br />CONTACT PERSON AND PHONE NO. <br />USE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN <br />LOT BLOCK <br />OF <br />FOUR <br />PROJECT ADDRESS <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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />x6� <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />u[ <br />s z <br />/ � L✓G/b� VTR/I l^+, <br />._ Or...--_/-�/ <br />MECHANICAL <br />PLU MBING <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />I <br />A/C—A/HNDLG UNITS H.P. <br />� <br />WATER CLOSET (TOILET) <br />� <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />BATHTUB <br />' <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />I <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />RANGEHOOD <br />DISHWASHER <br />; <br />WATER HEATER <br />- <br />LAUNDRY TRAY <br />WOOD STOVE <br />' <br />CLOTHES WASHER <br />METAL FIREPLACE &CHIMNEY <br />, <br />URINAL <br />FIREPLACE INSERT <br />' <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />i <br />GAS PIPING <br />' <br />BACKFLOW PREVENTERS <br />, <br />' <br />ROOFDRAINS— <br />E%HAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SINK <br />� <br />I <br />SUBTOTAL $ <br />I <br />SUB $ <br />PERMIT $- <br />pERMTOTAL <br />' <br />TOTAL FEE $ <br />' <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />rcw <br />BUILDING <br />PLUMBING <br />TYPE OF CONTE. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />BCWPAAC <br />CRIMP <br />Iw RBWFUIxc11NIT5 <br />MECHANICAL <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REDD HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVEflETT <br />LOCAL SALES <br />TAX CODEIS 3105 <br />TOTAL <br />RECEIPT <br />