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1 APPLICATIC A FOR CONSTRUCT ON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />A <br />HEATING SYSTEM IJ GAS ❑ ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />O ER MAILADD12 CITY 4- l� n3 PHONE <br />P� - / iT <br />1 <br />�I <br />`t117 <br />Mct <br />OC I! F L�ae <br />dE� <br />INtW HUvn vn ���.••••�•• __ <br />CONTACT PERSON AND PHONE NO <br />- -7-7(,,7 �� �✓ zilT `J <br />, / <br />�Q� Z <br />~ <br />� � <br />'• <br />CONTRACT PPICf Of WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />!�RGPOSEG=!ua <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 DESCRIPTION OF PROPEPIYISHOWN BELOW OR ATTACH FOU coPIESI <br />/ <br />IO BLOCK OF O Gt1LL �` <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 />_ OQ., <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION- IS MADE AND I COMPLY WITH THE STATE <br />CONTRfA T S L 18.27 R AND 29fi.200 WAC. <br />to�Al�q 2 <br />X <br />E o.iT <br />PROJECT ADDRESS <br />CITY 8W.ES5 UC1'111 <br />J 1I/ -7 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIC-AIHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT H QTERS-B.T.U. M <br />SHOWER <br />CLOTHES RYERS <br />KITCHEN SINK S DISP <br />VENTILATION, • AN <br />Dl WASHER <br />OOD*SINK <br />TRAY <br />EATER <br />SHER <br />OVE <br />IREPLACE & CH NEY <br />FOUNTA <br />CE INSERTAIN <br />MP <br />PREVENTERS <br />NGINS-RAINLEADERST <br />FAN <br />VICE -BAR, ETC.) <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE S <br />TOTALFEE $ <br />run urrlL m UJC <br />FRONT SETBACK <br />USE ZONE <br />-Z <br />W.`.. <br />REAR SETBACK <br />LOT AREA <br />�� <br />SIDE SETBACK <br />VACANT SITE <br />PLAN CIILCN IUMBER9 FE1/J <br />FEES <br />/� <br />VALUATION <br />IIL/C/E iPT NO <br />FEE <br />BUILDING <br />PLUMBING <br />LJ ? j <br />' <br />TYPE Of CONTS ALLOWABLE <br />A_j <br />TYPE Of CONST7XT At <br />V/ EY/ <br />ai�v <br />W(f MUxGUNIS <br />MECHANICAL <br />_ <br />SIZE OF BLOC. <br />5 y SF.zr. <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />I <br />CCCUPAN6YLOAD FIRES S/PRNKLERS REQ'D <br />I /1 V <br />REASON FOR SPRINKLERS <br />HEIGHT LIMITTTION <br />�) 11 <br />SPRINKLER <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />STATE BUILDING SURCHARGE <br />---�— <br />IJ�� <br />PUBLIC WORKS <br />i <br />INTAKE BY PLAN PR By <br />TOTAL <br />/'J�0 ; j l <br />