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APPLICATIO_. FOR CONSTRUCTLA PERMIT <br />1. rw,, TO BE COMPLETED IN INK —PLEASE FniiE I <br />CITY GA <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />PVCFPII <br />e <br />HEATINGSYSTEM: VGAS ❑ELECTRIC ❑ _ __ <br />COMBINATION BUILDING "ECHANICAL PLUMBING SIGN <br />m <br />A11CNIlECi qI pEBIGNFR MAk ADDRE55 CRY <br />DENER4 CONTRACTOR MALADDRESS CITY m PNONE LICENSE. <br />VP PLUNE <br />cusses roRN <br />it2`1NFW ADDITION ALTERATION REPAIR DEMOLITION WCODSTOVEIFRPL INSERT BUILDING RELOCATION <br />� <br />Cp1tRAL11'RCC OF WJIIN <br />CONIACI <br />PERSGN AMD PNDNE IRI /� _�j ('� <br />I J .Z) <br />MSCRBE YpM AND 90UARE FOOiAOE AnOLVEO <br />PnOPosFD 15E Dr PlM1DWG <br />I 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 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 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 />Cq flEPLON V O�AGENI DATE <br />l / 3 2£s-9/ <br />h't <br />X�al^'�n Erq 2/7 i"_ 7/7G. <br />LEGAL LESORIPTIDN OF PROPERTY ISHOYM BELOW ON ATTACH TWA COP.ESI <br />LOT___ BLOCB OF <br />PRWEn AODREes <br />/, For. FQ�y� <br />h '/ <br />Berg LICENSE ND eusMf1SNAME <br />p—, <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 OTOILET) <br />AC -A MNOLG UNITS -HP <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M EA. <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 />T <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 />CACKFLOW PREVENTERS <br />GAS PIPING p 7/ <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL E <br />SUBTOTAL <br />PERMIT S <br />PERMIT <br />TOTALFEE $ <br />TOTAL FEE E <br />S'00 <br />FOR OFFICE USE ONLY: <br />FRONT BElWN <br />REAR BFTBA.CN <br />SIDE YTBACIL <br />PL AN CHEC% NUMBER <br />EFF <br />RECFIPIM <br />USE SONE <br />LOT AREA <br />LACANI SET <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYROWwTsALUMNAE <br />TYRE NMT ACIWL <br />DAINw L'I PPYYUALIN'�F <br />Mw <br />-- <br />PLUMBING <br />BILEOEBLOG <br />NO OF STORES <br />BASEMEM <br />MECHANICAL <br />� 1PG <br />ADDIiIONALPUN CHECK <br />OCCUI'ANCYLOAD FIRE SMWLERS REOn HFNiM IBRtAlION <br />RfA$OAY FOR 6PRtMLERS <br />OTHER <br />STALE BUDDING SURCHARGE <br />WANE BY <br />PLANS ARWRED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICWCRKS <br />TOTAL <br />US 106 <br />