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APPLICATIO.. FOR CONSTRUCT►..lN PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the EvPrBreen <br />CITY OF <br />everett HENTINGSYSTEM ❑GAS DIELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-881 C <br />DEIeOLITION COMBINATION BUILDING ZIP <br />PMECHANICAP ONE 'PLUMBING ❑SIG <br />MAIL ADDRESS .,.✓ 98�c3 ggq_ 938i <br />,n.0 <br />Li-Ia5 �}i'IDL(� rn�� �IEYL � 121P PHONE <br />MAIL ADDRESS CITY <br />•_..... <br />LITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />21P <br />PHONE <br />LICENSE/ <br />GENERALCONTRACTOR <br />MAIL ADDRESS <br />GIN <br />ZIp <br />PHONE <br />LICENSE / <br />MECHANK:ALCONTRACTOR <br />MAIL ADDRESS <br />CIiY <br />CITY <br />ZIP <br />PHONE <br />LICENSE / <br />PLUMBINGCONTRACTOR <br />MAIL ADORESB <br />CLASS OF WORK <br />NEW ❑ ADDITION ALTERATION �C REPAIR ❑DEMOLITION WOODSTOVE/FRPLINSERT BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />PRICE <br />USE <br />LOT BLOCK <br />W_ r <br />OF <br />OR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED Ines <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />ePPIIS T CRYDU E>S LICENSE NO. AND BUSINESS NAME <br />UFzV <br />'� <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />UNITS—H.P. <br />' <br />WATER CLOSET (TOILET) <br />FORCED AIR SDLG <br />FORCED AIR SYSTEMS—B.I.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />T CLOHES DRYERS <br />' <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK & DISP <br />RANGE HOOD <br />' <br />DISHWASHER <br />' <br />WATER HEATER <br />— <br />LAUNDRY <br />WOOD STOVE <br />' <br />, <br />WAS <br />CLOTHESS WASHER <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />' <br />H_I TPUMP <br />FLOOR DRAIN <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />EXHAUSTFAN <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR, ETC.) <br />, <br />i <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT $ <br />I <br />TOTAL FEE $ <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK <br />ZONE I LOTAREA <br />TYPE OF <br />Gel <br />SIDE <br />BUILDING <br />awwxcr xa aovnulxc M,ns <br />^^" PLUMBING <br />CITY OF EVE <br />LOCAL SA' <br />TAX CODE IS <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />6-0 <br />/n7 i6_D <br />