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9HCHa <br />�H2 <br />Q m Q <br />xHx� <br />m H <br />OH <br />�08 <br />YH <br />t HH <br />8y <br />ZHtA <br />HO(n <br />APPI.ICATIiN FOR CONSTRUC ION PERMIT �% <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />259.8810 <br />DEMOLITION <br />OWNER'T f '1 <br />pgoT E^ 3]j <br />TENANT MA• <br />F _HEATING SYSTEM: 29 GAS ❑ ELECTRIC ❑ <br />'OMBINATION tiBUILDING a•MECHANICAL KPLUMBING SIGN qq <br />•DDRESS CITY ZIP PHONE ( (VI3 <br />A ]DRESS CITY ZIP - PHONE <br />ARCHITECT OR DESIGNER 1!AL K+WRE55 <br />Cltt <br />21P <br />PHONE <br />CITY <br />Zip <br />PHONE <br />ST ATE LICENSE <br />GENERALGONT RAcwn MAIL ADDRESS <br />5RrvU2_ <br />ZIP <br />PHONE <br />STATE LICENSER <br />MECHANICAL CCNTRACTOR MAIL ADDRESS <br />CR <br />55cig LpL7i " <br />ZIP <br />PHONE <br />STATE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />(DWI TE U. AS i P (.M <br />OLASS OF WORK <br />ncN+nl mnNl <br />WOODSTOVE/FRPL INSERT <br />BUILDING RELOCATION <br />KNEW ADDITION ALTEHA IUN <br />REMR - • ....... <br />3017 CONTACT <br />PERSON AND PHONpjTO. <br />Z`1 l (4u3 <br />CONTRACT PRICE OF WOPN Igo <br />DESCRIBE WORK AND SOUARE FOOTAGE INV VE <br />l-' <br />�T UCE <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USEOF BUILDING <br />I <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />K <br />APPLICATION <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTYISHOWNBELOIY OR ATTACH FOUR COPIES( <br />T PRESUME TO <br />NOT. THE VE <br />RTO OTF A PERMIT DOES OI <br />LOT BLOCK OF <br />VIOLAANTING <br />AUTHORITY E OR CANCEL THE PROVISIONS OF ANY <br />_ <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />�.1TC1 <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />'I <br />t46 7 �G�Q��{ <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 27 RCW AND 296.200 WAG. <br />/zq�tz <br />X <br />srv+roof <br />wlr <br />PROJECT ADDRE <br />s <br />[,, <br />0N51 <br />NO <br />c J <br />I/ <br />FEE <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />PLUMBING <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />A'C-A/HNDLG UNITS-H.P. <br />' <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS. B.T.U. M <br />i <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />( <br />KITCHEN SINK 8 DISP <br />RANGE HOOD <br />( <br />DISHWASHER <br />WATER HEATER <br />' <br />LAUNDRY TRAY <br />WOOD STOVE <br />I - <br />CLOTHES WASHER <br />METAL FIREPLACE & CHIMNEY <br />' <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />I <br />HEAT <br />_T <br />FLOOR DRAIN <br />I <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />EXHAUST FAN <br />' <br />ROOF DRAINS-RAINLEADERS <br />1 <br />SINK (SERVICE -BAR, ETC.IIla <br />Ile <br />i <br />SUB TOTAL $ <br />SUBTOTAL <br />S <br />PERMIT S <br />PERMIT <br />$ <br />TOTAL FEE 5 <br />TOTAL FEE <br />S <br />FOR OFFICE USE <br />ONLY: i <br />A 3 L <br />PLA HE NUMBER FEE <br />RECEIPT NO <br />RECEIPT ^7 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />+ <br />UREA <br />VACANT SITE <br />es <br />FEES <br />VALUATION <br />FEE <br />- <br />USE E <br />-, <br />.Z /3 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />TYPEOFCONTSA0.0WABW <br />TYPE OF NST. ACTUAL <br />McUmNP <br />NOM MUINGUNI'S <br />I <br />SIZE OF BLOC <br />NO.OF STORIES <br />BASEMENT <br />Ib'10 SF GaA <br />I <br />—� <br />OCCUPANCY LOAD <br />FIRESPRNKLERSREO'D <br />HEIGHTLIMITATION <br />ADDITIONAL PLAN CHECK <br />llJ <br />(iCJ <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />� <br />REA50 FOR SPRINKLERS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />"go <br />J <br />LOCAL SALES <br />3 <br />TAX CODE IS 3105 <br />TOTAL <br />$ + <br />