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BUILDING DEPARTMENT HEATING SYSTEM: I�Q GAS ❑ ELECTRIC ❑ <br />259-8810 �A <br />Ll DEMOLITION i I COMBINATION (`BUILDING ❑ MECHANICAL <br />OWn / MAJL•ADDRESS A A CITY ZIP _ PHC <br />PHONE <br />Ll PLUMBING L I SIGN <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />CONTRACT PRICjF OF WORK / <br />DESCRIBE WORK ANIYSCUARE F5019OE INVOLVED <br />CONTACT PERSON AND PHONE NO. <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 />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. 17HAT 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 L W 18 27 W AND 296.200 WAC. <br />zc <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK - OF <br />/ <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TE ON NUMB <br />2 <br />PROJEC A D S <br />�{ <br />scry URE er <br />CITY BUSINESS LICENSE NO <br />PLUMBING <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 />AIC—A/HNDLG UNITS—H.P. <br />, <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />�— <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />T <br />If <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WAT. R HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />- <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE —BAR. ETC.) <br />SUB TOTAL <br />S <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTALFEE <br />S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REARSETBAACCK /J <br />SIDE SETBACK <br />PLANCHE KNUMW <br />FEE <br />RECEIP�TTNO. <br />USE ZONE <br />.— <br />LOT AREA <br />VACANT SITE <br />YES -. NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />5 <br />_r <br />/v <br />TYPE OF EDO$i <br />NO. OF STORIES <br />aB o;oaflu•,c utPs <br />PLUMBING <br />SIZE OFB DG //�� <br />.Zzo S,F7T <br />68o SF G9� <br />FIRE SPRINKLERS REDD <br />BASEMENT � <br />YES ✓Np <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARMREOD <br />HEIGHT <br />ITIJIMITATION) <br />OTHER �v <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANSA 0 ED BY <br />J <br />DATE cj�1 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBUCWORKS <br />TOTAL <br />; zn <br />