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APPLICATIQ 1 FOR CONSTRUCT-INPERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: )q GAS LI ELECTRIC ❑ <br />259-8810 <br />L1 DEMOLITION COMBINATION I_l BUILDING 11 MECHANICAL Li PLUMBING ❑ SIGN <br />CA DbgN R <br />MECNANCALCONTPACTOR <br />Zw <br />ZIP <br />ZIP PI"E STATE LICENSE <br />ZIP PHONE STATE LICENSE <br />PLUMBING CCATRACTOR MAX ADDRESS CITY ZIP PHONE STATE LICENSE <br />co'Zr PR'cE a wam <br />PCIPSASEY AND ARE FOOTAGEIN VE' <br />CONTACT PERSCN AND PNCNE NO <br />I HEREBY CERTIFY THAT 1 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 Wi!FT'IE11 SPECIFIED HEREIN OR <br />NOT. 9E 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 REGULATWG CONSTRUCTION OR THC <br />PERFf RMANLE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF ISPROPERTYPERFORM ANDI HEKFORWHICH <br />STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAG. <br />PROPOSED USE OF BUKPPID V <br />- <br />LEG.M DEst vrKPf oP VROPERtY ISNQ.YH BELOW OR ATTACNTMO COPES( <br />T BLocK QP <br />�s D-oa AI iim <br />PARCT ITNIIMBEn n <br />—EFr - 3- 3'O LLY <br />CDNSTRMTgNLOANFENDER. ADDRESS.TELEPIICNEN N— <br />PROJECT ADDRESS' /Oeo <br />7 St� �CI /--�i <br />9_I� �w r <br />cmeirs.Assiluwsr <br />ra <br />PLUMBING <br />MECHANICAL <br />Eq. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A.IG—A HNOLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 OISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WDOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />r <br />FLOOR DRAIN <br />NEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING _ <br />ROOF DRAINS—RAINLEAOERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT E <br />PERMIT E <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FRONT SETBACK <br />7-5- <br />USE <br />�� <br />REAR SETBACK <br />7-5 Y <br />m <br />LAREA <br />�GY OOU <br />SIDE SETBA9< <br />�.s <br />VACANT SITE <br />❑ YES ✓,'NO <br />PLAIN CHECK NUMBER <br />iii o <br />FEES <br />IEE <br />iyh.�� <br />VALUATION <br />RECEiP}/p�/O� <br />6 <br />FEE <br />BUILDING <br />— <br />PLUMBING <br />20 5IP5 <br />l(D vo <br />TYPE DFCDYSI <br />NO a STORIES <br />// <br />PiVwKY J V Mtun4wm <br />Ra OF BUID <br />FIRE SPNINRlERS PEQD <br />BASEMENT <br />MECHANICAL <br />0" SC Awk) <br />OCNPANCV FOAB <br />AIUIA <br />410 <br />FIRE M.AnM READ <br />n YES [✓O <br />N, ,TEIM'TAT� <br />76 <br />ADDITIONAL PUN CHECK <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />IYV <br />INTAKE BY <br />PLANS APP lEo BY <br />CITY OF EVERETT <br />LOCAL SALES <br />PuoucwoRKs <br />DATE 1,onTAX <br />CODE IS 3105 <br />TOTAL <br />2 1 > 0 <br />