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APPLICATIC� FOR CONSTRUCrt:�JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />EATING SYSTEM � GAS ❑ ELECTRIC IJ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL oNE PLUMBING SIGN <br />MAIL ADDRESS (nccI Z/Ip <br />AY�NER /\ .. TY <br />A, II-'R 1 _ _� n_I HI.n/_'7,_� l.I <br />- <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />- PHUNt <br />CITV <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />Zlp <br />PHONE <br />STATE LICENSER <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />ZIP <br />^ ^- <br />PHONE <br />�.,-/��/ /-'^ <br />STATE LICENSE 0 <br />/) AA i/ C Al <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />ADDRES�S/'�y�� <br />CITY <br />A n, <br />��p �� <br />I <br />� ( <br />�� <br />l L F-C <br />(�EIPH�ONE !L ^f' <br />I,STTAl, <br />h�Cn-1'. _'•. Ih0 <br />II ]L�! Ld <br />_SiT! <br />ZIIPUI_.-j4N <br />L7.CELNRL <br />Pi uuRlNr. cnNTRACT R <br />MAILADDRESS <br />Ty <br />Ty <br />� <br />nc-_. <br />11n i ... <br />. AY11/C Al :1067A?�L <br />CLASS OF WOR <br />ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />I NEW AUDITION <br />CONCST PE'RSSON AN PHONENO <br />[�I <br />I�••(1J�}/G/` <br />CONTRACT PRICE OF WORK �'� / <br />/ / / <br />L• /� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />6 act <br />a F <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />OPOSEOUSEOF BUILOINC <br />I HEREBY <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DES' TION OF PROPERTY (SHOWN BE OW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />I <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESI )ME TO GIVE <br />LOT BLOCK of <br />—{ <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />f�� / Q �� <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />AM AUTHORIZED BY THE <br />1 `Y <br />PERFORMANCE OF CONSTRUCTION. THAT I <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CTORS LAW 18. W AND 296.200 WAC. <br />C)C <br />p �QIECT ADDRESS j/J7 <br />SIGNATURE pAT[ <br />- <br />/// 7r <br />CITY AUSINE55LIGENSE NO <br />/1 <br />MECHANICAL <br />PLBM/BINf/Ga <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />AC-A'H VDLG UNITS-H.P. ' <br />WATER CLOSET (TOILET) <br />FORCE D AIR SYSTEMS-B.T.U. M E.A. ' <br />BATHTUB - <br />UNIT HEATERS-B.T.U. M ' <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER — <br />' <br />VENTILATION FAN _. <br />KITCHEN SINK & DISP <br />RANGE HOOD ' <br />DISHWASHER <br />�, <br />' - <br />WATER HEATER <br />LAUNDRY TRAY - <br />WOOD STOVE ' <br />_ <br />CLOTHES WASHER - <br />METAL FIREPLACE & CHIMNEY '• <br />URINAL <br />FIREPLACE INSERT ' <br />DRINKING FOUNTAIN' <br />I <br />HEAT PUMP <br />FLOOR DRAIN <br />' <br />GAS PIPING �— <br />BACKFLOW PREVENTERS <br />EXHAUSTFAN ' <br />ROOF DRAINS-RAINLEADERS <br />' <br />SUB TOTAL <br />$ (I'- <br />SUB TOTAL <br />$ <br />PERMIT <br />$ ' <br />PERMIT <br />$ <br />TOTAL FEE <br />TOTALFEE <br />5 <br />FOR OFFICE USE ONLY: <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />LAN C/H/ECN NUMBEP. <br />`1 K /M E-p <br />I / <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />LOT AREA <br />I <br />BUILDING <br />DF LONiS. ALLOWABLE <br />ttPE OF CONST. ACTUAL <br />ASITE <br />OF DW[LDNG UXIISTYPE <br />PLUMBINGSIZE <br />OF BLOG. <br />NO.OF STORIESMECHANICALADDITIONAL <br />PLAN CHECKOCCUPANCY <br />LOAD <br />FIRE SPRNKLERS REO'D <br />TION <br />I <br />SPRINKLER <br />I <br />REASON FOR SPRINKLERS <br />STAIE BUILDIN3 SURCHARGE <br />' <br />PLANS APPROVED BV <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />INTAKE By <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />�� <br />