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APPLICATICI FOR CONSTRUCT-3N PERMIT � <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS ❑ ELECTRIC <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER / MAIL ADDRESS CITY �` ZIP �F PHOI.E <br />,4 <br />TENANT� MAIL ADDRESS---ve• 4PA� �"K <br />CITY 71P PHONE <br />e+uy�lltarye IZ9 �ssyi,�.t%twi9v� 5, ,rE�►7' ,99a3Z ass'-36as <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRA D MAIL DORESS CITY zip PHONE �p STATE LICENSEY <br />�f1/rrj(/��J/�C ?s��'ST sE/icer JBi2'JF� -a?& sa+Y�ss�3i <br />MECHA )CAL CONTRACTOR MAIL?DDRESS CITY ZIP PHONE STATE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />�( NEW ADDITION ALTERATION REPAIR nFNAnI ITInNI Ielnnncrnvv,­ <br />'----._._.....-UUiwnw ncl_vL.rnvrv <br />CONTACT PERSON AND PHONE <br />�/� <br />CONTRACT PRICE OF <br />NO. <br />WORK <br />G• <br />DESCRIBE WORK AND SQUARE FOOTAGE I..VOLVED <br />�.Srv6!„�' <br />lf0 ElLClzIC N�Av <br />PROPOSED USE 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 />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTgCH FOUR COPIES) <br />LOT 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 />C�7 <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />AiISL <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />_ <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 />1 ' z <br />PRROJJEECTADDRESS <br />2jA�TU DATE <br />— <br />1 BIISME55 LICEHS[ HO <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 />I <br />A/C-A/HNDLG 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 />' <br />_ <br />SHOWER <br />' <br />DRYERS <br />KITCHEN SINK & DISP <br />_CLOTHES _ <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />I <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAINi <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />; <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SEi CN 11 <br />EAR SETBACK <br />SIDE SETBACK <br />PfA�HEO�UF.IBER <br />/(S <br />FEE 9; <br />7APT NO�� <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDINP <br />TYPE OF CONM ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />MCUPUdY <br />ceoua <br />I.00FCAfUIUG0-IS <br />PLUMBING <br />I ' <br />SIZEOFOLJG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />AJDIT;ONAL PLAN CHECK <br />I ' <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT7L�I/MI%TA}T-I—ON <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />�r— <br />INTAKE BY <br />PLANS APPROVED BY <br />JIVI <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />I <br />TOTAL <br />7_,�G <br />G I <br />