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APPLICATIG.j FOR CONSTRUCT,JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 0#:77- <br />BUILDING DEPARTMENT HEATING SYSTEM: L-JGAS ❑ ELECTRIC ❑ --- <br />259-8810 <br />l 1 DEMOLITION Li COMBINATION ✓EIUILDING I I MECHANICAL I I PLUMBING i I SIGN <br />CITY <br />T <br />TLNANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE I <br />— <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATELICENSE0 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br />CLASS OF WORK <br />IVNEW 17 ADDITION 1. 1 ALTERATION REPAIR I DEMOLITION WOODSTOVE/FRPL INSERT ! I BUILDING RELOCATION <br />CONTRACT PRICE OP WORK <br />COrJT/�CLPER$J AN Q�jI"[H�+ /� ✓�� / ! V <br />��AND SQUARE F� TAGE INVOLVEI�V^�j , IG <br />Ci/•JLW1nTl1/✓ �t7L(�:/L/i1'T'S Y lU �� � <br />1I �I,1/1 �'�'lJ'���D . <br />V <br />PnOPoSED USE ;FS �DIryC <br />�9i <br />I I <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 />CONTC� RS LAW 18.27 RCW AND 296.200 WAC. <br />X �r <br />LEGAL DESCRIPTION OF PRCPE9TY(SHOWN BELOWOR ATTCP. FOUR PIES) <br />Lor� BLOCK —__ OF <br />.(' ( <br />L PG. <br />_ <br />— - <br />-- <br />PROJECT ADDRESS <br />✓1 IL/�� <br />� <br />ATU <br />• / <br />CITY 1 NESS LICE SE NO <br />PLUMBING <br />ME HANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-A'HNDLG UNITS-H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />_ <br />UNAT_ORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M- <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIM <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PR NTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAT RAINLEADERS <br />EXHAUST FAK <br />SINK (S ICE -BAR, ETC.) <br />; <br />� <br />I <br />� <br />I <br />I <br />_ <br />I <br />� <br />SUB TOTAL $ <br />SUB TOTAL 8 <br />; <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />�— <br />FOR OFFICE USE ONLY. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />- <br />PLANCHECK NUMBER <br />FEE <br />REC TNO. <br />LQ <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />--I <br />{IIIviooBUILDING <br />O <br />G <br />I — <br />TYPE OF CONTS. ALLOWABLE <br />TYPEOFCONST. ACTUAL <br />°ccuruln <br />R0 <br />xl ov mvEurocuxns <br />T%� ) <br />PLUMBING <br />r <br />SIZE OF BLO <br />ZVT2. �F �- <br />NO. OF STORIES <br />EASEMENT <br />MECHANICAL <br />T <br />C/zf, S" GAR. <br />0 <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY L AD <br />FIRE SPRNKLERS REO'D <br />FIF.I T IMITATION <br />-SPR NKtlH— PA bon) <br />/p ' <br />it! <br />No <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />`J <br />LOCAL SALES <br />TTAX CODE IS 3105 <br />TOTAL <br />ZZ 9 <br />1 <br />