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APPLICATICI FOR CONSTRUCT )N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: VGAS U ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING 11ECHANICAL PLUMBING SIGN <br />Eq MAIL ADDRESS CITY PHONE <br />PHONE <br />TENANT )PII MAIL ADDRESS CITY ZIP <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />AY <br />GENERAL pONTR CTf� <br />MAIL ADDRESS <br />CITY 21P <br />PHONE <br />STATE LICENSE A <br />M€CNANICAL CON CTOR <br />\\�AIL <br />y Sb \ <br />' <br />\\\ <br />E V <br />PLUMBING CONTRACTOR <br />SG m <br />MAIL AD RESS <br />'� "S ` ' CV)a, (C l <br />CITY ZIP <br />PHONE <br />STATE LICENSE A <br />CLASS OF WORK <br />ITInM <br />wnnnSTOVFiFRPL INSERT BUILDING RELOCATION <br />L NtW AUvi I IUn <br />CONTACT PERSON AND PHONE NO. <br />oO <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE F TA OLVED <br />S�r) b �J.l�. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILPINg <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 />OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW 'TEGULATING 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 AND 296.200 WAC. <br />X <br />GcJ1•IJ� U <br />SG[)ATE <br />CITV BU5MES5 LICENSE NO <br />PLUMWNG <br />FEE <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />1 <br />A/G-A/HNDLG UNITS—H.P. ' <br />' <br />1= <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />1 <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />RANGE HOOD <br />WATER HEATER <br />1 <br />LAUNDRY TRAY <br />� <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />METAL F IAEPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />HEAT PUMP <br />GAS PIPING <br />�— <br />ROOF DRAINS—RAINLEADERS <br />1 <br />EXHAUST FAN <br />-- <br />SINK (SERVICE --BAR, ETC.) <br />1 <br />T <br />I <br />1 <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />P <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USE ZONE <br />LOT AREA <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />SIZE OF BLDG. <br />NO. OF eTORIES <br />OCCUPANCY LOAD FIRE SPRINKLERS RED <br />REASON FOR SPRINKLERS <br />INTAKE BY <br />PLANS APPROVED By <br />SIDE SETBACK <br />PLAN CHECK NUM ER <br />VACANT S'TE <br />FEES <br />BUILDING <br />pCCUPANty <br />NO IXbXELLiHG UNITS <br />GROUP <br />PLUMBING <br />MECHANICAL <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />HEIGHT LIMITATION <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT I PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />RECEIPT <br />pNa <br />pyn <br />nON <br />ppY <br />N <br />