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everett <br />APPLICATIA FOR CONSTRUCT N PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />Yv. (AB Evergreen <br />CITY OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-BB10 <br />11 DEMOLITION i COMBINATION IJ BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ACDPE$ CITY / ZIP PHONE <br />Qy�l��iF �Sjter /joXl t�^��ur•i� li—�52 <br />TENA MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR OESIS' R MAIL ADDRESS CITY ZIP PHONE <br />ILA I �r <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/ <br />.' I <br />MECHANICAL CO <br />TRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSER <br />PLUMBING CO 1 CTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSER <br />CLASS OF WORK <br />'. 000nlo I I nrAAnl mnN V WnnoSTOVE3FRPL INSERT" ! I BUILDING RELOCATION <br />}/- <br />CON`RACT PRICE OF WORK 0�,Jr j(�I GI <br />CONTACT PE SON AND PHONE NO. <br />DESCRI E WORK AND SQUARE F,00 AGE INVOLVE , <br />oldli- <br />PROP�QsE_URFBUILDING <br />�`''— LJ _ <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 LATE <br />X <br />LEGALDESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK _ OF <br />— <br />_ <br />PROJECT ADDRESS <br />n In/] /—ov/L <br />APPLICANTS CITY BUSINESSIIGEN5E N0. ANDBUSR:ESS NAME <br />PLUMBING 11 <br />MECHANICAL — <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />ABC—/VHNDLG UNITS—H.F. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN)-- <br />_ <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />_ RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FUUN IAIN <br />FIRCPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP _ <br />' - <br />BACKFLOW PREVENTERS <br />_ <br />GAS PIPINu _ <br />ROOF DRAINS—RAIN�EADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />_ <br />�T <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />INQO IVL I ICO !11,II V� <br />FRONT SETBACK V •` <br />REARSETBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />ILE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE OF CONTS. ALLOWABLI <br />TYPE OF CONST. ACTUAL <br />KcurACY <br />GROUP <br />No OF DWRONf WIS <br />S IZE OF BLDG. <br />140. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANOYLOAD FIRE SPRNKLERS REAL HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />I <br />—�— <br />STATE BUILDING SURCHARGE <br />INTAKC BY <br />✓LANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />- PUBLIC WORKS <br />TOTAL <br />3' (/ ;oz) <br />