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AP'PLICATIC ; ��)R CONS7'�RUCT: )N PERMI i ���" <br />TO BE COMPLETLD IN BLACK INK-PLEASE PRINT <br />I HEATWG SYSTEM: J GAS J ELECTRIC �J ____ I <br />BUILDING DEPARTMENT - - - <br />259-8810 <br />DEMOLITION COMBINATION BUILDING /F�ECHANICAL PLUNiBING SIGN <br />nRCMRECT OF DESIGNER <br />GENF.RALCGNTR�CTOR <br />ldAIL FOORESS <br />IdA1L nD�PE55 <br />IdAIL ApDRESS <br />rHy <br />PtU�A01NGC0"lTMCIDWI 't.10.ILA0�fiE55 <br />l/ <br />CONTRACT PRiCE OF TWORK <br />I/� l � <br />D[SCRIBE YJOFk �ND SOUARE FOOTAGE INVOLVE� <br />PfiOPOSED USE OF BUIL[11NG <br />LEGAL DESCBIPTIOtI OF PROPERTV �SHOIVN BELOW OR ARACN iW0 COPIES) <br />LOT BLOCK OF <br />��mice� rnx i o. Nur.+eerv <br />�9�� /� D�S D?�S. <br />COYSiRIICiiON LOAN LFNpER. F�ORESS, TELEPMONEXU61�ER <br />PROJ <br />NO. TYPE OF FIXTURE OF I-� <br />WATER CLOSET (TOILET) <br />BATNTUc <br />LAVATORY�WASH BASIN) <br />SHOVvER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, �iC.1 <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />IiiGNiSETBACK REAR 5[TBACK <br />i15EZONE LOTAREA <br />iVPEOFGOtISI. NOAFSTORIES <br />SIZEOFBLDG. FIRESPflINNLEFSREO'D <br />UCCUPANCYLOnp FIRE4LAR61FE0'D <br />RGASON <br />IIILIXEBY PLINSAPPRGVEDFIV <br />nn�r <br />CITY 21P <br />CITV 21P <br />CITY ZIP <br />GIl'Y 21P <br />FEE <br />PHONE <br />PNONE £'ATE �ICENSE n <br />PHONE STATELICENSEY <br />PMONE STqTE LICENSE a <br />CONT�Ci Pf-�i50N AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE RE�D AND EXAMINED THIS <br />APPLICATIGN AND KNOW THE SAME TO BE TRUE AND CORRECT. �LL <br />PROVISIONS OF LAWS AND OFDINA�:CES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRCVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUC710N OR THE <br />PERFORAIAMCE OF CONSTRUCTION. THAT I AM AUTI�ORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR W4�CH <br />APPLICATION IS !dADE AND I COMPLY WITH THE STATE <br />CONTRACTOAS LAW 1827 RCW AND 296200 WAC. <br />SiG' �ir =[!"`„� _/���J <br />�--r*- <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />A�C—A�HNDLG UNITS—H.P. <br />FORCED AIR Sl'STE(dS—B.T.U. `�i'v1 E.A. <br />UNIT NEAiERS—B.T.U. M <br />CLOTHES DRVERS � _ <br />VENTILATICN FAN ; <br />RANGE HOOD �_ <br />WATER HEATFR ' <br />VJOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSEF?T <br />HEATPUMP <br />GAS PIPING ' <br />EXHAUST FP,N � <br />SIDESETBACK PL1MCt�ECH'IU�d3ER �EL <br />VACANT SITE FEES <br />-�. YES — NO 9ui�oirvs <br />o�cur>ncr i.o o�oc[�ouaunns <br />canur PLUMBWG <br />BnSEMENT MECHANICAL <br />:7 YES �_. NO <br />HEIGMT u1dITATION AD�ITIONAL PLAN CHECK <br />OTHER _ <br />STAiF �UILDING SURCHARGE <br />CITY Of EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 31D5 TOTAL <br />SUBTOTAL S O;C)U <br />PERMIT 5 I i OU <br />TOTAL FEE S � " r— <br />R[C[IPT N0. <br />VALUATION FEE <br />I <br />_ �. <br />i <br />� <br />T <br />