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APPLICATION FOR CONSTRUCTI-ON PERMIT <br />TO BE CL,..IPLETED IN BLACK INK —PLEASE PRIN. <br />HEATING SYSTEM: U GAS <br />U ELECTRIC <br />U <br />JILDING DEPARTMENT <br />i9.8810 <br />DEMOLITION COMBINATION X BUILDING <br />MECHANICAL I I PLUMBING SIGN <br />MFfl MAIL ADDRESS <br />dogr/y4 co.. Pa. <br />CIryry <br />Ciar'22o'7 M(SoF �[�SC,+TzE,WR• <br />ZIP <br />PRONE <br />`L�- <br />NANT MAIL ADDRESS <br />CITY <br />71P <br />PHONE <br />jkF116 YA% <br />CIIITECT OR DESIGNER MAR ADUBkSS <br />CIIr <br />lll' <br />PIIONI: <br />- --_- - <br />—71P <br />NInAL CONIRACI011 MAIL ADDRE. 65 <br />CIIY <br />PIK)Nf: BTME LICE Nti1 <br />19—_gusTNN CO• <br />-__. <br />_ <br />CIIMKIAL CONTRACTOR MAIL ADDRESS <br />DITY <br />ZIP <br />PHONE STATE LICENSER <br />IMBING CONTRACTOR MAIL AUDRESS CITY <br />STATE LICENSE F <br />A5SOF WORK <br />Ncw I I AnnITInN u'i ALTERATION I I REPAIR I I DEMOLITION I (' WOODSTOVEIFRPL INSERT I I BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO <br />NtRACT PRICE OF WORK <br />SCRIBE WORK AND SQUARE FOCRAdE INVOLVED <br />OPOSED USE OF SUADWG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />lUltiFoaCIE <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />OAL DESCR-PTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <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. THAT I AM AUTHORIZED BY IHE <br />— <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 RCW AND 296.200 WAC. <br />x ia. y �9Y <br />'w- wtF <br />o,EciADOREss <br />' 1 /� q <br />�• 44swo4, RD 4p,-^lJ <br />CItYBUSiNl99l Y-(NSF HO <br />PLUMBING <br />MECHANICAL <br />40. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. —I <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SVSiFM_5—B._T.U. _M-E.A. <br />—_—' <br />LAVATORY (WASH BASIN) <br />?— <br />UNIl HEATERS—B.T_U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS_ <br />! <br />_ <br />KITCHEN LINK d DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />-_�_— <br />URINAL <br />_� <br />' <br />METAL FIREPLACE IL CHIMNEY <br />! <br />_ <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />_--+ <br />i <br />PUMP <br />B_ACKFLO_W PREVENTERS <br />_ <br />-_ __ <br />_HEAT <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />___; <br />�_ <br />_ <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />_ <br />T <br />- <br />1 <br />1 <br />—T <br />� <br />I <br />I <br />SUBTOTAL $ <br />i <br />SUBTOTAL E <br />—� <br />— <br />PERMIT S <br />PERMIT _ $ <br />— <br />TOTAL FEE $1 <br />i <br />I <br />I TOTAL FEE E <br />' <br />nI, neClre "CC nul v. <br />GNT SETBACK •• v <br />HEAR SETBACK <br />M <br />SIDE SETBACK <br />VIMCHECK NUMBER <br />FEE <br />RECEIPT NO <br />,E ZONE <br />IOT AREA <br />VACANT 6I1E <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />G 7.: ,•p <br />I <br />' <br />PL BI CBNIS ALLOWABLE <br />tyPE BI CBN9F ACT DAL <br />Ofi11111Lr <br />IID gM1llAF•YMIA <br />N OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />,CUPANCY LOAD FIRE SPARKLERS REOD <br />A504 FOR SPRINKLERS <br />HEIGHT LIMITATION <br />_ <br />SPRINKLER <br />i <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />--- --- <br />STATE BUILDING SURCHARGE <br />-- <br />FAKE BY <br />PIINS APPROVED BY <br />I►1 <br />PUBLIC WORKS <br />I <br />TOTAL <br />• <br />