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APPLICATIC'1 FOR CONSTRUCT'IN PERMIT <br />TO FIE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: ❑GAS LIELECTRIC U <br />259-8810 <br />LI DEMOLITION I COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br />OW11[p YAt ABw[SS /� CITY <br />T��. (l_.,, -», /i1,�iJA !Z, , %r 5'aoy t�sa - 93co�. <br />MAT <br />ZIP <br />ARCHRECTOADESIGNER MAIL A009ESS OFF ZIP PHCRE <br />RWBm]Cpl{pACTOp MAILACURESS CITY ZIP PHOKE STATE LFENSEP <br />CORTRACT PRICE DF WORK <br />OESCR9E KORK AND SONARS FMIAGE INVOLVED <br />CDNIACT PER" ANO RIONE NET <br />7 <br />1 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 HZRE1N 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 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRALTO LAW I B 27 RCW A^ND 296.200 WAG. <br />=P D DIrs BUILD <br />LE64 DE..,P1 aPR vERnlsuwm BuowaR AnACH TnommESl <br />TUT BLOCK OF <br />vARtEL TAK c NDMD(R <br />CCNSTRGCipN EOAY IE•DER. ADDRESS. TELEPHONE NtAWFIl <br />PROJECT ADDRESS <br />3fD U- <br />/V <br />wp <br />PLUMBING I <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AG—A'HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />LAVATORY(WASH BASIN) <br />UNITHEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK $ OISP <br />VENTILATION FAN <br />�— <br />—�— <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />�— <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />�— <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />FOR OFFICE IISF ONLY. <br />FROYt SETBACK <br />REABSETBACK <br />SOE SETBACK <br />PLANC•IECKHUVB[P, <br />A D�� <br />EEE <br />RECOPTND <br />USE ZONE <br />LOTFRUA <br />v1 BRE <br />O YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />LYHCPCpIST <br />NO Ci STORIES <br />gdNR� <br />aAv <br />Lp ppIIlLT.ubtT <br />SMEOFSLDO <br />FIRE SPRINKLERS RECO <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY Lw <br />FIRE.ALAROREQO <br />HE9N[LmITA1gN <br />OTHER <br />REASCN <br />STATE BUILDING SURCHARGE <br />1• <br />INTAKE BY eY <br />7�SRovEDerCITY <br />OF EVERETT <br />LOCAL SALETAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />