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APPLICATIC. 1 FOR CONSTRUCT_ JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT �w <br />BUILDING DEPARTMENT HEATING SYSTEM:GAS ❑ELECTRIC ❑_ <br />259-8810 <br />DEMOLITION COMBINiTION BUILDING MECHANICAL PLUMBING SIGN <br />DWYER "AL ADDRESS CITY ZIP PHONE <br />A'kL !/�/1,5ECCIV I?7/5 6RII MI? ads .4/21� Q&O / ZS9-470 <br />TENANT MAa ADDRESS CITY ZIP PKAAE <br />ARCHITECT CH DESIGNFq MAR ADDRESS CRY ZIP PHONE <br />GENERAL CONTRACTCA MAq ADDRESS CITY ZM PHONE STATE LICENSE• <br />STATE <br />NEW i I ADDITION IA_TERATION REPAIR DEMOLITION WOOCSTOVEIFRPL INSERT BUILDING RELOCATION <br />LdAgALF PRIf.[ CF WJfIK /O� _ <br />CONtAct PIRSON RND PIIQN[HJ <br />fNSLPIREJVAMK AND SQUARE FWiAGE NVIXVEO/ <br />Priorosm usEaq//uaomG <br />a,��j(C <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED - 3 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOPK 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 PROPERT-/ TO PERFORM THE WORK FOR WHICII <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA RSLAW 27RCWAND296200WAG <br />-- DATE - <br />- <br />IBGALDESLAI"Mx PRGPERtYIsgGWm SELMQRAnACNFWRCOPIS) <br />toi BIQLK of <br />PPNEC�I apDRLS ,E-, �- - <br />01y/I� VF/�*•Y) E I <br />F <br />PLUMBING <br />ECHANICAL <br />NO. <br />TYPE OF. IXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A.C-A HNOLG UNITS-H.P <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNITHEATERS-B.TU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINKS DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINB-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETD) <br />SUBTOTAL E <br />SUB TOTAL E <br />130 <br />PERMIT $1 <br />PERMIT E <br />TOTALFEE $1 <br />TOTAL FEE E <br />FOR OFFICE USE ONLY: <br />RgNT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NWDER <br />FEE <br />RFCFV9 V0 <br />usE zoiIE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-_ <br />nfEBFCONTS M_pVAB1f <br />TYPE (A WNST. ACNN <br />agmv.A <br />eAar <br />A9 M(Mluni RMP <br />PLUMBING <br />SIZE OF ELM <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />OCCUPANCY LOAD FIRESPR LERSREOD NE IONS LMITATp <br />REA" FOR SPRINKLE AS <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANSAPPROVEDBY CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />