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e� <br />Wmi <br />APPLICATIO.d FOR CONSTRUCTL JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />MAIL ADDRESS /� // CITY ZIP <br />�J1pWgEq q 1 <br />__.. uen enngcss CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERALCONTAACTON <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEY <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />PUIMBWG CONTRACTOR <br />MAILADDRESS <br />CLASS RK <br />♦l-__. <br />ocNAlo nPAArn rrION <br />WOODSTOVE/FRPL INSERT <br />BUILDING RELOCATION <br />INtW ARUL"TIG" .._...... <br />__ - <br />-f <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPUSE OF BUILDING <br />PROPOSE <br />' <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />O <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />BLOCK OF <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 />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�yxAivgF DATE <br />PROJECUODRES <br />/vim <br />Lrtv BUS^A'S5 t¢F16(NO <br />� � � <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A'C—A'HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.TU. M EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />�; - <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES HER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />------------- <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HE AT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />r <br />EXHAUSTFAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE S <br />TOTAL FEE S <br />' <br />Lr , I Ic0 nwN V. <br />rvn vr1 Iv.e_ U— <br />v..L.. <br />PLAN CHEGN NUMBER <br />cEE <br />— <br />n[CDPT NO <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />3 31 <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />iYPE OF CDNiS ALIOWABIf <br />iYT BI CDNST. ACIlIAL <br />nRowxcr <br />AO IXbMuwc urns <br />— <br />q <br />exav <br />PLUMBING <br />SIT I OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLER3REOD HEIGHT LIMITATION <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />wraKE By <br />PLANS APPRovEoeY <br />CITY OFEVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />