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5I'll <br />APPLICATI16d FOR CONSTRUCt BON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILPING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑_ <br />25 810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OW11EB II ADDRESS CIVvc � <br />ZIP PN E <br />CNZ; n / A, T^ -✓ L� vi S yy/3��,Y✓ <br />TENANT MAIL AppNEES%i. <br />ARCHITECT OR DESIGNER MAX ADDRESS CRY ZIP P,"E <br />GENERAL CONTRACTOR MAIL AW4[SS CRY ZIP PR E STATE LICENSE <br />MLCNANCALCONTRACTOR MAIL ADDRESS CRY ZIP ALONE STATE LCENSEA <br />1'LOMBINGCCNIRALIOR MA4ADDRESS CRY ZIP PADNE STATE LCENYA <br />CLASS OF WORK � <br />MFw er,nITInM Al TFRATION REPAIR IV6EMOI ITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CWTRALIPPCE CF VRMK� ol�a- <br />COL IACI PEPSCN AxDP/�p��NF/rg <br />7•lo cf <br />DESCRRE WURKAND SGWRE FOOTDE INVOLVED <br />_ — <br />/�/%<rrNY <br />O/q.If • ��/ <br />yLr <br />�gprpsED usE D INn �/� �r n <br />HEREBY CERTT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANDHE SAMEi0 BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORN WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME i0 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 />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 296.200 WAD. <br />t[cM wgrlDN PnoPERry IVNOWNeaoM MAT tea FGURc E <br />i t BLOCK, OF (� _ ', <br />B ILQ <br />[ Ttj <br />a <br />PPOhCT ADDLESB <br />PLUMBING <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 />A C-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 />KITCHEN SINK A DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.( <br />— <br />SUBTOTAL S <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE $ <br />C/YO ZACRIPC I ICF FYNI V. <br />ERDNI SETBACK <br />PURBEIBACM <br />SIDESEt 11 <br />PLAN CNECKNNMSLR <br />35 /.,G. <br />FLE <br />RECEIPTPO <br />use ZONE <br />LOY AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />_ <br />TYPE DE LONGS AU MASU <br />TYPE Of ml ACEUM <br />Rnlw�Ar <br />AARA <br />AO PPM��mcw •1 <br />PLUMBING <br />SIZEOFBLDO <br />NO OFSTORES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS PLOD NECM IIMRATCN <br />REASONFORSPRMKtERS <br />SPRINKLER <br />--�� <br />STATE BUILDING SURCHARGE <br />MTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICWORKS <br />TOTAL <br />