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m p M <br />9 H3 CA <br />Upv <br />0 <br />CIO <br />H <br />O <br />OHd <br />Hag <br />>z>y <br />rHF3 <br />gCA <br />O En <br />APPLICATIC A FOR CONSTRUCI.ON PERMIT ; <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />--1 <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ - <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />PHONE <br />OVrti[R MAIL ADDRESS , CITY ZIP <br />D VeJr ��ac� � . ,40E, £� _�5,L• 9gvy <br />ZIP PHONE <br />TENANT MAR ADDRE55 G 0' n' <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />G(OAL GINTRACTOR <br />n M1OJ L.U_T <br />MECHANICALCONTRACTOR <br />MA DDR 5 <br />W, uwl,�aS�E,L <br />MAIL ADDRESS <br />r �� ZIP PHONE <br />L DoL q80� 3 �3-�S 7 e&EL6— <br />CITY 21P PHONE <br />STATE LICENSE <br />553 <br />STATE LICENSE/ <br />PLUMBING CONTRACTOR <br />MAh ADDRE55 <br />C" ZIP PHONE <br />STATE LICENSE <br />CLASSOFWORK <br />m,n„TInKI wnnnRTnVFIFRPL INSERT <br />BUILDING RELOCATION <br />NEW ADDITIUry <br />CONTACT PERSO`J <br />' �� /•^t`-Jl-1L <br />CONTRACT PRICE OF WORK <br />DES C IBE W RK 50UARE FOOTA INVOLVED np <br />-yL�__T+ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <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 DEBCRIPTION OF PROPERTY) SHOWN BELOW OR ATTACH FOUR COPIES) <br />43$ '3G 1 Q D' O <br />LOT BLOCK �, OF 1 <br />NOT. THE GRANTING OF A PEFMIT 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 THr. <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA � NO 296,200 WAC, <br />q <br />i==z=== <br />DATE <br />- <br />PROJECT ADDRESS <br />Cityfl1151YF551iC�I15E110 <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />WATER CLOSET (TOILET) <br />_ <br />A/C-A�HNDLG UNITS-H.P. <br />' <br />FORCED AIR SYSTEMS-B.T.0 ]M E.A. <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />_r <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />RANGE HOOD <br />WATER HEATER <br />LAUNDRY TRAY <br />' <br />_ <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE B CHIMNEY <br />_ <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />--------�— <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I <br />T <br />SUBTOTAL $ <br />SUBTOTAL $ <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE <br />ONLY: <br />REcemr eo <br />FRONTSETBAOK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />3 1 <br />FEE <br />'FEEDS <br />VALUATION <br />FEE <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />BUILDING <br />i <br />TYPE OF CONTS. ALLOWABLE TYPE Of CONSi. ACTUAL D:C1-Pv xD q(M'FuwG onus <br />PLUMBING <br />I <br />SIZE OF BLDG. No OF STORIES BASEMENT <br />MECHANICAL <br />I <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCY LOAD FIFE SPRINKLERS REO'D HEIGHT (IMITATION <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />TOTAL <br />