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APPLICATION FOR CONSTRUCTION PERMIT L'VE•TPLI <br />rnP eYrlerrPA TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY Or everett HEATING SYSTEM GAS O ELECTRIC U _ <br />BUILDING DEPARTMENT f' <br />259.8810 <br />DEMOLITION I : COMBINAMON _ I BUILDING MECHANICAL 1 I PLUMBING1112 <br />SIG <br />10 <br />N N <br />2 oQ <br />rb n S¢q:• <br />H y <br />�pJ N H <br />fi [C70 <br />CO N <br />O w <br />h <br />n 'I-, -s . <br />AR REGT OR DCSIGNER MAIL ADDRESS <br />CITY ZIP PHONE <br />GENERAL CONTRACTOR MAILADORESS Cliv ZIP PHONE <br />LICENSE F <br />GLASS OF WORK <br />'DEMOLITION ! ' WOODSTOVE/FRPL INSERT El BUILDING RELOCATION <br />F <br />I <br />I <br />I. I NEW I I ADDITION Pq ALTERATION I . REPAIR '._I <br />CONTACT PERSON AND PHONE NO. <br />qQ/� <br />//49, <br />CONTRACT PRICE OF WORK d <br />D E WORK AND SOUARE FOOTAGE INVOLVED - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSE USFOFnugDINO J <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />�LW.�CCGA�GI <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />-LEGALOESCRIPTIONOF�ROPERTY TSN BELOWOR ATTACH FOUR IESI <br />NOT. THE VE <br />ING OF APRESUME PERMIT DOES NOT <br />Lot BLOCK OF <br />V OLAATEOR CANCEL THE PROVSIONS OF ANY <br />/ <br />AUTHORITYRTOT <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />.12 <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 10.27 RCW AND 296.200 WAC. <br />SIONAIURE�ROR AUTHORIZED ENT GATE <br />PROJECT ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO ANO OUS.NESS NA <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. TYPE OF EQUIPMENT FEE <br />N0. <br />A/C—ATHNDLG UNITS—H.P. ' <br />. WATER CLOSET (TOILET) <br />r,2 FORCED AIR SYSTEMS—B.T.U. M E.A. lJ'Od <br />BATHTUB <br />—HEATERS—B.T.U. <br />UNIT B.T.U. M <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />' <br />CLOTHES DRYERS <br />SHOWER <br />SINK d OISP <br />VENTILATION FAN <br />KITCHEN <br />DISHWASHER <br />_.... <br />RANGE HOOD <br />- <br />WATER HEATER <br />— <br />' <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE S CHIMNEY <br />' <br />URINAL _ <br />I <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />_ ' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />F <br />OF DRAINS—RAINLEADERS <br />E%HAUST FAN <br />_ <br />SINK (SERVICE —BAR. ETC.( <br />— <br />I <br />I <br />SUB TOTAL $ <br />I <br />; <br />SUB TOTAL $- <br />- PERMIT $ <br />_ <br />_ _ _—_ <br />__ PERMIT $ <br />— <br />TOTAL FEE $ <br />TOTAL FEE <br />A.11 V. <br />FgON15ETBACK` <br />vREAR SETBACK <br />SIDE SETBACK <br />PLANCHECKNUMBER <br />FFF 'RECEIPT <br />NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />_FEE T— <br />BUILDING <br />I <br />_�— <br />TYPE OICONTS.ALIOWABII <br />1VK OF CONST. ACTUAL <br />DLNNIA+ <br />A9pPYIUAG unit <br />PLUMBING <br />_ r <br />SIZE OF BLDG NO OF STORIES BASEMENT <br />OCCUPANCY LOAD FIRE SPRINKLERS REOD HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANB APPNOVEO B'� —' CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />