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APPLICATIC J FOR CONSTRUCT _ JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS <br />WELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />PLUMBING <br />f14EMOLITI�O1N, <br />COMBINATION <br />/rB�UILDING <br />i SIGN <br />O`WN-ER <br />ADDRESSI <br />CITY <br />IM <br />ZIP PHONE <br />P3S.�a�a9 <br />1 ��1 � ((I�eleWAn <br />. <br />f 4K6 <br />E14 <br />Q,v`MECHANICAL <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />510f.V_A� <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY__ <br />ZIP PHONE <br />11'' <br />�4vokm <br />�03 3S3�9S31 <br />inn I�A"QS <br />(41g w1AM&r1 <br />GENERAL TRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSE I <br />&kM ETr— <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSE I <br />6wnejI.-INi1 <br />PLUMB CONTRACTOR <br />_ <br />MAIL ADDRESS <br />I A. -. <br />PHONE I <br />CITY ZIP NE STATE LICENSE <br />- - I I lY�� i A �u _ -41 <br />CLASS OF WORK � �� <br />1 1 Ncw u/AnnITRTN AI TFRATICIN REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK"' I a /'/ in <br />CONTACT PERSON <br />1 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />1 Q <br />PROPOT <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />j`�W, <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 PRO TY (SHOWN BELOW OR ATT H FOUR COPIES) <br />LOT BLOCK _jam of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESIIME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />P <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 />Y� <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />sP-43 <br />X� <br />PROJECT ADDRESS <br />SCNATURE DAIT <br />Cltt BUSINESS LICENSE NO <br />PLUMSNIO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />I <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 />CLOTHES DRYERS <br />_ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />I_ <br />( <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK SIDE SETBACK <br />"J'" <br />PLAN CWE�CKK NUMB/E-R/n FEE <br />RE T / <br />USEZONEZONE <br />LOT AREA + <br />` <br />VACANT SITE <br />/ L' <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE OF COATS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />—� <br />of uZN" <br />Gav <br />NO aVMIONGUNITS <br />I <br />MECHANICAL <br />SIZE OF BLDG, <br />1061 st DD <br />NO. OF STORIES <br />BASEMENT <br />NO <br />ADDITIONAL PLAN CHECK <br />i3 <br />OCCUPANCY LOAD FIRE SPRNKLERS READ HEIGHT LIMITATION <br />N/a ^f0 I <br />PEASON FOR SPRINT LERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />' (- <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED By J <br />�a <br />i . �a <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />