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�1 <br />APPLICATIA FOR CONSTRUCIft- N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />[I DEMOLITION Cl COMBINATION ��t BUILDING �� 5S <br />I// -I MECHANICAL I. I PLUMBING [ SIGN <br />IP <br />��/MAIL ADDRESS CITY <,c-- k &,*ffwow—&u- P Z PHONE <br />GA/ /l /43-7390 <br />Iervnni <br />nev Qrc�m tnac�u �/C16 N ARA) 1&26 rd, U u <br />l <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY IP EIS G I r PHONE(? r, � <br />, I � ?i lQ 0u <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE Y/ C� STATE LICEN✓SE0 V <br />i i I / t'GhrnL iie-9'�'/'RZ ?/'-D2V7 r/3�Gd <br />tAECHAN AL CONTRACTO / MAIL ADDRESS CITY ZIP PHONE STATE LICENSE k <br />PLUMBING CONTRACTOR ✓ MAIL ADDRESS CITY ZIP PHONE STATE LICENSES <br />CLASS OF WORK � <br />t,Y <br />r i <br />. <br />. <br />, <br />I <br />� <br />,•v <br />� <br />o <br />, <br />. <br />n <br />. <br />T <br />, <br />l <br />. <br />n <br />., <br />n <br />,. <br />l a <br />_ <br />aela <br />.. <br />]FMOLITION �WOODSTOVEIFRPL INSERT ' I BUILDING RELOCATION <br />I I NEW I nuuu <br />_ <br />-- CONTACT PERSON AND PHONE NO. <br />CONTRACT ?RICE OF WORE <br />DESCRIBE -WORK SQUARE FOOTAGE INVOL:�EO <br />PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT GAVE 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 ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK of 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 />RACTORS LAW 16.27 RCW AND 296.200 WAC. <br />/I/, in <br />SIG#RE#� DA E <br />PROJECT ADDRESS 3ytt S6 ty"If - ��� CITE DJ <br />YY PLUMBING W !/-_^- MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) SIC—A/HNDLG UNITS—H.P. <br />BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) UNIT HEATERS—B.T.U. M <br />SHOWER ' CLOTHES DRYERS <br />_ KITCHEN SINK & DISP VENTILATION FAN <br />_ DISHWASHER ' RANGE HOOD <br />LAUNDRY TRAY ; WATER HEATER <br />CLOTHES WASHER WOOD STOVE <br />URINAL ' METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN FIREPLACE INSERT <br />—FLOOR DRAIN ' HEAT PUMP <br />FL <br />BACKFLOW PREVENTERS ; GAS PIPING <br />ROOF DRAINS-9AINLEADERS ' EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ SUB TOTAL $ <br />PERMIT $ PERMIT S <br />TOTAL FEE $1 TOTAL FEE $ ' <br />FOR OFrI%,c LAac <br />FRONT SETBACK <br />FOR OFrI%,c LAac <br />FRONT SETBACK <br />v1111-1. <br />REAP. SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE � <br />RECEIPT N- <br />✓ <br />`J <br />USE zoNE <br />�r-rtREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />9UILDING <br />' <br />d � <br />Qp# <br />0 <br />TYPE OF CENTS. ALLOWABLE <br />TYPE OF CONST. ACTUA'. <br />OGCUPANIY RG OF MILLING LNITS <br />' <br />GROUP / <br />PLUMBING <br />SIZE OF BLDG. <br />NO.. OF STORIES <br />CASEMENT <br />MECHAN'CAL <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCY LOAD FIRE SPRNKLERS BEG HEIGHT LIMITATION <br />I <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />REASON FOR SPR. NKLERS <br />INTAKE OY <br />PLANS APPROVED BY <br />CITI OF EVERETT <br />PUBLIC WORKS <br />I <br />LOCAL SALES <br />JI l� 3 <br />TAX CODE IS 3105 <br />TOTAL <br />