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APPLICATIO, FOR CONSTRUCTI N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC f3'-di& <br />259-8810 <br />DEMOLITION COMBINATION BUILDING -MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CRY ZIr PHONE <br />QP,lMca CRC. 80. ebx'470ZMs��C%4_. g -+ 3+2-587A <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />MEyCIIANICALCONTRACTOR MAIL ADDRESS CITY 71P PHONE STATE LICENSE <br />WVWESNEtJT SAID. �U _%5=97 Ml"TVSIZIm <br />PLUMBING CONTRAC TOR MAIL ADDRESS CI V ZIP PHONE STAFF LICENSER <br />CLASS OF WORK <br />NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />S ' / <br />7 S v) <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGF INV(5LVED <br />%4s=j I&WILATW aXl4ALW <br />FbL CIC, <br />PROPOSEDUSE OF BUILDING <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 />O. HER 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 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RRCW AND 296.200 WAC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />SUN.T� oArE <br />CRY OVSMESS LICENSE NO <br />FLUMBINQ <br />MECHANICAL <br />NO. <br />TYPE OF FI7(TURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-3.T.U. M <br />�— <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHFR <br />I <br />WOOD STOVE <br />URINAL <br />i_ <br />METAL FIREPLACE & CHIMNEY <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 />-- <br />I <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />bD <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTALFEE $ <br />S' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />//,_.36F9oi <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF COATS ALLOWABLf <br />TYPE Of CONST ACTUAL <br />uccurNNcr <br />No aF MILLING araS <br />GEMP <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />AIF.CHANICAL <br />�7r ri-i <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD IIEIGM7 LIMI TATIO! <br />SPRINKLER <br />_ <br />REASCII FUR SPRINKLERS <br />—�— <br />STATE BUILDING SURCHARGE <br />19aNE Br <br />IIANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />