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APPLICATION FOR CONSTRUCTI& PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />IAe EWITTIPen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />nag 0010 <br />HFATINn SYSTEM: ❑ GAS ❑ ELECTRIC U <br />BUILDING <br />MECHANICAL <br />PLUMBING SIGN <br />DEMOLITION <br />COMBINATION <br />—I O R <br />MAIL ADDRESS <br />LILY <br />ZIP AM SdZ-EO �J <br />ZS"L- 3779 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR <br />MAI ADDRESS <br />CITY <br />ZIP PRONE <br />LICENSE# <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CRY <br />ZIP PHONE <br />IILENSE• <br />PLUMBNGCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE <br />T/ocoAlo ncLI ITTnN WOOLSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO - {y /J JLYV% <br />- •(J yQO 3L'� <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE MVI. <br />v <br />P 0POSEo usE OF emLmNG <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 IIEREIN OR <br />LEGAL DESCRIPTION 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 18.27 RCW AND 296,200 WAC. <br />SIGNATURE OFF CONTRACTOR OR AUTHORIZEDAGENT DATE <br />'O Ld%f0 <br />PROJECT ADDRESS <br />s 3�� <br />ASPLICANTS GIN BUSN+ES C NSE NO. AND BUSINESS NAME <br />L . <br />PLUMBING <br />MECHANICAL V <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />A/C-A'HNDLG UNITS-H.P, <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY'RAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 6 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 />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />I-vn vrr•v� ems•- <br />FRONT SEIBACN <br />•+••�• <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />usEZONE <br />LOT AREA <br />VACANT 6ITE <br />FEES <br />VALUATION <br />FEE��/�� <br />BUILDING <br />---------5�_-�-i =-�- <br />TYPEOFCONTSALLOWABLE <br />lYPEOF CONST ACTUAL <br />TNOUMt1LM4 uAiTF <br />-- <br />PLUMBING <br />— <br />61ZE Oc 0LOG <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />LOAD FIRE SPRNKLERS RECTO HEIGHT LIMITATgN <br />EREASON6PRMKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />�7T�/_[/ <br />PUBLICWORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />7 <br />