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APPLICATION FOR CONSTRUCTN PERMIT everett <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />FA/ EYBrgrreO <br />CITY OF <br />everett HEATING SYSTEM: IJ GAS ❑ELECTRIC U --- --- l <br />BUILDING DEPARTMENT <br />259-8810 <br />I I DEMOLITION I I COMBIN-A'TTION 7 �BUILDIN/G` �yMECHANICALPHONE <br />PLUMBING SIGN <br />DRESS CITY ZIP <br />TENANT <br />MAIL ADDRESS <br />CITY <br />71P <br />PHONE <br />ARCHITECT OR IIESIGNEn <br />MAIL ADDRESS <br />CITY <br />71P <br />PRONE <br />GENERAL CONIRACIOn <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />LICENSER <br />MEC'MANICAL CON I RAIJ I On <br />MAIL AUDnFSS <br />CITY <br />ZIP <br />PIIOHE <br />LICENSE IT <br />e/!WAG7/ <br />LICENSE/ <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PIIONE <br />CLASS OF WORN <br />.. 1 - ncAAnl mnnl >nnnsiovEiFRPL INSERT ! I BUILDING RELOCATION <br />I I NEW 1 • AUUIIIUIN r.0 <br />_. <br />CONTACT PERSON ANp PIIONF. NO <br />CONTRACT PRICE OF WORK <br />BE E WO1RK ANOSOO E FOOlAOE INVOLVED <br />6J0ewS7yp" <br />PROPOSED USE or rum DING <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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCmPnoN or rnurenly lsnowN BELOW on nrucn coon corlER1 <br />or <br />NOT. 111E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT_ nLocK <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 />-- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />SIGNATURE 017 CON ILIAC ION o11 AIR I IONIZED AGEN I DATE <br />—�- -- -- --- --- <br />/JV <br />�- LISS�/v///JJ <br />P E T ADDRESS <br />,� / <br />Y "-- <br />II PI (CNTS CITY ROLICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />_ NC-AHNDLG 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 />SfiOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />r_ <br />_RANGE HOOD <br />LAUNDRY TRAY <br />_r <br />WATEP HEATER <br />- <br />ASHER <br />CLOTHES WASHER-- <br />_ <br />�__ <br />WOOD STOVE <br />' <br />METAL FIRE PLACE &CHIMNEY <br />' <br />URINAL <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP-- <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINL_EADERS - <br />�— <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />1 <br />_ SUB TOTAL $ <br />1 <br />3Q <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $--.---r—_ <br />--- <br />TOTAL FEE $ <br />_ <br />__- <br />TOTAL FEE $ <br />36 <br />rvn vrrn.c voc <br />vnu. <br />_ <br />rFE <br />RECEIPT NO <br />FRONT SE TRACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />USE ZL.S <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />IYPI Or CONTS AUOWAAN <br />IYPF OF CONST. ACIIIAL <br />IKcwwv <br />IIUOIOALIWAIMOS- <br />AN^10' <br />PLUMBING <br />MECHANICAL <br />SIZE Or BLDG. <br />NO. Or SIORIES <br />BASEMENT <br />ADDITIONAL PLAN CI IECK <br />OCCUPANCY LOAD <br />FLOE SPRNKLERS REOYI <br />IIEIGIII LIMIIAl10N <br />O111ER <br />-- <br />REASON FOB SPnINKI EDS <br />STALE BUILDING SURCIIARf,F <br />1 <br />� <br />INIAKF.BY PLANS APPROVEDOY CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />3L1 <br />