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lu i AA" <br />APPLICATI.,Iiry FOR CONSTRUCTkiN PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the, E , e r <br />CITY OF }} <br />everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION 1 1 COMBINATION BUILDING-.'4ECHANICALN c l PLUMBING SIGN <br />ADDRESS <br />GENERAL CON TRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />-rsP6 �� baa-G�ia <br />n CHANICAL CONTRACTOR MAIL Aqo esr /���/x CITB� /�/L 21P PHONE �} ICENSE0 <br />' �- nn \"if,�F�v24- I R21&,_lY 9cn72 Sly-OqS� � Irh�9�as ci <br />B <br />ik <br />i <br />1 'VL <br />ZIP <br />CLASSOFWORK , n�nele -I nI:AAro mnM - WnnosiOVEIFRPL INSERT I� BUILDING RELOCATION <br />><Z�NtW '_: HL1L1111u1Y :_� n...cnnu�,. ._, ..�...... .__ <br />__.___.. <br />- <br />CON TPERSON AND PHON N <br />/�' <br />� <br />� J-� <br />CONTRACT PRICE OF WORK V <br />DESCRIBEWORKA SDUAR OOTAGE VED <br />PROPOSE SEOFBUILDING <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 />LEGAL RIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT <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 MADE AND i COMPLY WITH THE STATE <br />CONTRACTORS LAW 18. ND 296.200 WAC. <br />r /S/Q O <br />_SIGMA FCONTRACTO ORAUTHORIZ AGENT DATE I <br />PRO ©ADDRESS <br />S S� <br />APPLICANTS CITY BUSINESS L CENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />Np, TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—AMNDLG UNITS—H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE B CHIMNEY <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />a <br />I <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />I <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' " <br />run vrri ua._.,..c.. <br />FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OFCONST. ACTUAL <br />oUUPANtY <br />Ko avATuiNt UNi15 <br />4Rd1P <br />PLUMBING <br />SIZE OF BLDO. NO.OF STORIES BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERSREO'D HEIGHTLIMITATION <br />OTHER <br />i <br />REASON FOR SPR'"S. L <br />STATE BUILDING SURCHARGE <br />INTAKE BV <br />PLANS APPROVED OY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />i <br />LOCAL SALES <br />T <br />TAX CODE IS 3105 <br />TOTAL <br />; dd <br />