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H <br />C H <br />> I.3 14 <br />tH"zH <br />� 0 <br />H �I <br />O::O <br />mH�e <br />.Ty.. V1H <br />L7 Q <br />HC <br />OH <br />-I A <br />ZH <br />9H <br />t" H <br />HH <br />gCO3 <br />CA <br />M <br />ZH3ED <br />H3 0 CO <br />APPLICATIa.4 FOR CONSTRUCT. JN PERMIT <br />the Evargreon TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF [i <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP <br />- <br />ZIP <br />MAIL ADDRESS PCB <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />Cltt <br />ZIP PHONE <br />LICENSE# I. 1%wTc.+•Iv.`^• <br />Exca0a-L'n <br />1533�-)014 PI. I.J. L <br />u1 <br />?tip <br />MECHANICAL CONTRACTOR MAIL ADDITE5*1 <br />CITY <br />ZIP PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />CLASS OF WORK <br />� <br />rll ovoAlo VfYLAAfYI mnN <br />I-�� WOODSTOVE/FRPL INSERT <br />- <br />'J BUILDING RELOCATION <br />co arerA; PHtD%n�l I ­7 L4 3-q Lrl-A) <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />-� <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT_ <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 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />NAATU'REOFCONTRACTOR ORAUTHORIZED /AGENT <br />�/(� DATE <br />SIGV&P <br />�f o—'PROTECT <br />ADDR E SS 1C�INESSLILENSENO <br />AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STMCHIMNEY <br />URINAL <br />METAL FIRDRINKING <br />FOUNTAIN <br />FIREPLACFLOOR <br />DRAIN <br />' <br />HEAT PUMBACKFLOW <br />PREVENTERS <br />GAS PIPINF <br />DRAINS—RAINLEADERS <br />EXHAUST <br />' <br />SINK (SERVICE —BAR. ETC.) <br />I <br />' <br />I <br />' <br />I <br />1 <br />SUB TOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />rvn v w <br />..�•• <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />oml <br />AO 0OWBLIM MITS <br />Gmp <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANOYLOAD FIRE SPRNKLERS REDD HEIGHT LIMITATION <br />I <br />OTHER <br />1 <br />REASON FOR SPRINKLERS <br />�%1 <br />STATE BUILDING SURCHARGE <br />LJ <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/l�60 <br />