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i <br />l <br />�AMW <br />APPLICATION FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT f <br />Tire Evergreen <br />CITY OF <br />everett HEATING SYSTEM: 0 GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAKADDRESS <br />ITENAN� MAIL ADDRESS CRY ZIP PHONE n <br />.'1n..— s-�r F� I.—.c-1 �_.-�. •kA AI�K.. .. lr I� Q2 r,-f�T1L�, /{t I, <br />Chi 7 <br />PLUMBING CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE• <br />­ IV rce Anna ' 09PAID DFMOLITInN WOODSTOVEJFRPL INSERT C BUILDING RELOCATIC` <br />CONTRACT PRICE OF WORK A ` L,�\ <br />/ACT PERSON AND PIgH€N0. l 1 l / /-� <br />I-IDL 7'?(e e11 I <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />1 • (` <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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />✓l. , 4ii7N Co <br />LEGAL (5ESdmPticN OF PROPERTY ISN ELOW OR 4TTACH FOUR COPIES) <br />LOt BLOCK OF <br />_ <br />.- <br />PROJWTADDRES� <br />/ <br />APPLICANiSY SNESLICENSENOAND BUSINESS NAME <br />CI <br />PLUMBING <br />MECMANICAt-- <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AC—AHNDLG UNITS—H.P. <br />BATHTUB <br />If 117, <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 8 DISP <br />VENTILATION FAN <br />—_ <br />DISHWASHER <br />RANGE HOOD <br />— <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHESWASHER <br />—�— <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />r <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 />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />O <br />PERMIT <br />$ <br />PERMIT $ <br />/S <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />Eno ncclnC "CC f1ml V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />3-7c <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE DI CENTS. ALLOWABLE <br />TYPE OF COHSE. ACTUAL <br />aSUAv<r <br />G." <br />OnvrrtuI%G IMITG <br />SIZE OF SLOG <br />NO.OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE SPRINKLERS REO'0 <br />HEOHT LIMITATION <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC. WORKS <br />TOTAL <br />