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APPLICATI01'°FOR CONSTRUCTIN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS 0 ELECTRIC 0 <br />259-8810 <br />L1 DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS _ .,.J? CITY ZIP F, MI <br />CITY ZIP PHONE <br />ARCHITECT OR ?P N-ER MAIL ADDRESS CITY ZIP PHONE <br />1 N Y��� <br />GfW,"LCCNTRACTOR MAIL ADDRESS CITY ZIP PHONE sTATrllrcuec. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LIC N <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE L.CENSEa <br />IAAJJ ur WUNK <br />I I NEW 1 ADDITION I I ALTERATION / REPAIR DFMOI ITInN - Wnnnarnvrarool mceo,• <br />CONTACT PERSON AND PHONE NO. - -- vV •__"• , „` ' 1 V 1, <br />/^ <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVEDPROPO <br />—'- <br />I <br />sED USE OF BUIUCNG <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT-- BLOCK <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PIiESIJME 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 A 296.200 WAC. <br />X f. ��" <br />SIGNATUREi�6— DATE <br />PROJECTADDRESS <br />O Ste. <br />CITY BUSNESS LICENSE NO <br />PLUIAIINO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FE'_ <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C —A HNDLG UNITS—H.P. <br />_ <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 />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />I <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />; <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />' <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />3 & <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />2 <br />i <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />DCCuwACY <br />GROP <br />WM MLLINGUNILS <br />> <br />PLUMBING <br />SRE OF SLOG. <br />NO, STORIES <br />BASEMENT <br />MECHANICAL <br />i <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE S NKLERS READ HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED 6Y <br />Qj I '� k( <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />