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y <br />C H <br />A H VJ <br />H 'H <br />y YZ H <br />I< C] <br />H 7D <br />H fH/JH <br />Z <br />Htl <br />Q H <br />Hm8 <br />a• o <br />ZH <br />�y1 <br />rAA y <br />gdCOO <br />R�t. <br />H3va <br />0rh <br />APPLICATION FOR CONSTRUCINON PERMIT <br />IM EvorprPen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />eve rett HEATING SVSTEM;>OAS ❑ ELECTRIC ❑ --� <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMO ITION 1 COMBINATION BUILD) G MECHANICAL PLUMBING SIGN <br />CWNI O II MAIL ADDRESS CZIP PHONE <br />u0 �J(Y14 IIV ►�In�p �>D�ltt P°f82o1 -- �dL�`�C32_ <br />Gk ERAL ON FACTOR AAILA RE S CITY Z PHONE LIGE S <br />It,71G - WE 79�Q,.,�x-x OF5"l <br />ME ANICALCONTPACTOR VALL ADDRESS CITY ZIP PHONE LICENSE <br />4 VTr- 317v7 SiE.Qacc vE­ <br />PLUMBING CONTRACTOR MAIL ADDRESS C11Y 21P PHONE LICENSER <br />CLASS OF WORK <br />Al TFRATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />" .1 <br />CONTRACT PRICE OF W WORK ' LA <br />DES RISE RK AND aOUAR FOOTAGE INVOLV II <br />PRo ED USE OFB RING <br />Ae ,2 <br />LONTA .T aER NO N 10. <br />I 1 <br />�cgru OL s <br />REBV CERTIFY THAT I HAVE REA AND EXAMINED THI5 <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 />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 REGULA G CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCT) A I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY.TO PERF09M THE WORK FOR WHICH <br />APPLICATION IS MADE'AND -It O PLY TH THE STATE <br />CONTRACTORS LAW 18. AN 96. 00 WAC, <br />SIGNATURE OF RA UTHORIZ AGE DATE <br />L PROPERTY ISO OWN BELOW OR ATTACH FOUR COPIES) <br />Lo A ... Lor.K ,J of <br />OA <br />—;APPLICATION <br />PROJECT AUCRE' <br />AI <br />y� <br />CITY SINES LICENSE NO. AND ,INESS NAME <br />PLUMBING --�— <br />MECHANI L <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />ATC 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 />_ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />i <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEAT PUMP <br />BAOKFLOW PREVE ERE <br />GAS PIPING , <br />OF DRAIN AINLEADERS <br />EXHAUST.FAN <br />SINK(SERV —BAR. ETC.) <br />T <br />77 <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL: SE $ <br />TOTAL FEE $ <br />cno nccN c "CC nAll V. <br />FRONT SETBACK <br />/0F <br />REAR SETBACK <br />/V <br />SIDE SETBACK <br />- — <br />PLAN CHECK NUMBER <br />9 <br />FEE /� <br />Tv pP CBIl P r Ad <br />RECEIPT NO <br />USEZONE ^� <br />^!� <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TVPF UECRNTS ALLDWAdLL <br />LYPE DI CD TACTUAL <br />Ruuruxr <br />xn wowlulAcua's <br />PLUMBING <br />SIZE OF BLOC�j ` <br />IS �Q e� <br />NO OF STORIES <br />fK <br />BASEMENT <br />MECHANICAL <br />A9W1901AL PLAN CHECK <br />(p 6—: ;Iff <br />OCCUPANCYLOAD FIRE SPRINKLERS REOD HEIGHT LMITATION <br />35 F <br />REASON FOR SPRINKLERS <br />INTAKE BY PLANS APPROVED By CITY Of EVERETT <br />II INTAKE BY PL�AFISA�l/ LOCAL SALES <br />(� J✓� / TAX CODE IS 3105 <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />y 9 9 a8 <br />>I <br />mg <br />LI <br />