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APPLICATIQI FOR CONSTRUCTIPN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 4�ff <br />BUILDING DEPARTMENT <br />259-8810 <br />: DEMOLITION <br />HEATING SYSTEM: GAS ❑ ELECTRIC Ll _ <br />COMBINATION BUILDING <br />E, <br />f 1 PLUMBING SIGN <br />CIXIIflnCI PIIICE CF WJ11Y. ((// ll <br />OESCnIBE wglN ANO SQMRE FOOTAGE IMOLVEO <br />CONtALT PEflSp, AHOPHONE ,q <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 LIVE <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 />APPLICATION IS OF+ A I COMPLY WITH THE STATE <br />CONTRACTORS / RCW14ND296.200WAC. <br />\I <br />PROPOSED USE OF BUMOM <br />LEGAL DESCRIPTION Or PROPERTY SHORN Brow OR ATTACH RNO COPIES) <br />LOT RL..CK OF <br />vnRcn rA Nur En <br />OJ �? DOO� <br />CONSTRUGTNNILOINLENDER. ADDREss TE{rPOOVE u:rmrR <br />PROJECT ADDRESS <br />FIVNAvrt w+L <br />it BUBMLS:IKIW Ml <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 />A'C—NHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER 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 />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT E <br />PERMIT $ <br />TOTALFEE S <br />TOTAL FEE $ <br />C7' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REARSETBhCn <br />SIDE SETBACK <br />PUN CHECK MILDER <br />FEE <br />RECEIPT NO. <br />SS9� <br />GSEID E <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE _ <br />YES ❑ NO <br />BUILDING <br />TYPE Of CDNSt <br />NO OF STORIES <br />IIRLWAI' go PAtuAc W, <br />LAX, <br />PLUMBING <br />SMEOFEUM <br />FIRE SPARKLERS FEUD <br />BASEMENT <br />MECHANICAL <br />❑ YES 11 NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HFZWT MTARCN <br />OMER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TorAL <br />DATE <br />TAX CODE IS 3105 <br />