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APPLICATICA FOR CONSTRUCT ^mON PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM. GAS U ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />! I DEMOLITION COMBINATION BUILDING XMECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />TEF�tRV �RRRDL� I�r4 V�•R6ja) A A� foEREf1- 'I zs9-b'!7z <br />TENANT T—_ MAIL ADDRESS CITY ZIP v PHONE <br />ARCHITECT OR DESIGNER MAIL <br />CITY <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />MECHANICAL CONTRACTOR MAIL ADDRESS Grit/ ZIP PHONE STATE LICENSER <br />PLUMBING CONTRACTOR MAIL <br />NEW ADDITION ALTERATION <br />CITY <br />PHONE STATE LICENSER <br />REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTACT PIERSON <br />CONTRACT PRICE OF WORK Z5W <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />G1X �d�iD � FA[+'rol� 6�1s tab s�S <br />PROPOSEDUSE OF BUILDING owmx <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRTJv15IONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />,nT BLOCK OF <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 THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />AI'PLiCATION IS MADE AND I COMPLY WITH THE STATE <br />C:JNTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SrvOTaB 7-7f DATE <br />PROJECT ADDRESS <br />CITY 9U51NFS5 LICE: NSE NO <br />PLUMB NG <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE C7 ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />AlC-AJHNDLG UNITS-H.P. <br />P' THTUB <br />FORCED AIR SYSTEMS-B.T.0 M E.A. <br />_ <br />LAVATORY ('WASH BASIN) <br />UNIT HEATERS-B.T.U. M_ <br />—� <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />T <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />-'— <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PPEVENTERS <br />- <br />GAS PIPING <br />; <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />r <br />r <br />r <br />i <br />SUB TOTAL $ <br />SUB TOTAL $ <br />r'O r - <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />Ene nCCIf V I ICE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />a330 <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />r <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />ottu°AYCT <br />xa or pgEWxG uxns <br />PLUMBING <br />i <br />SIZE OF BLD3. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />T <br />I <br />i <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOI FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />i <br />SPRINKLER <br />REASON FOR SIFF.INKLERB <br />STATE BUILDING SURCHARGE <br />r <br />INTAKE By <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />r <br />LOCAL SALES <br />, <br />TAX CODE IS 3105 <br />TOTAL <br />