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-APPL <br />1 ATI <br />I FOR CONSTRUCT— <br />DN <br />PERMIT <br />TO BE <br />COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: &GAS <br />❑ ELECTRIC <br />❑ <br />259-8810 <br />� <br />❑ DEMOLITION <br />❑ COMBINATION [ 1 BUILDING <br />V ECHANICAL <br />LI PLUMBING ❑ SIGN <br />/�NLL./ <br />�111 <br />MA� TA^ODRESS <br />�E �ECC <br />��O A�CLTY <br />'S�J Like. <br />/A}1lp <br />l <br />ZIP= ` [l�(.'Q'fPHHOON� <br />/ <br />F <br />[/�� ��%P /� <br />���// <br />TENANT <br />MAIL ADDRESS <br />Y I <br />CITY <br />. fr <br />ZIP <br />PHONE <br />lill4lSfl <br />ARCHITECT OR DESIGNER <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />MECHANIC ONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE0 <br />S 1' <br />l0 I e �c x <br />G4<� <br />•{�-( 6sp 'bo35Fc 153u <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEN <br />CLASS OF WORN <br />Af NEW ❑ ADDITION <br />Cl ALTERATION <br />I_ I REPAIR I I DEMOLITION <br />I_ I WOODSTOVE/FRPI <br />INRFRT 1-1 RI III FLAY, MFI 0PATInKI <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />_ww <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />A ► iknt.(i j, <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />W <br />LEGAL DESCRIPTION OF PROPERTY ISHON BELOW R ATTACH FOUR COPIES) <br />Lor_L2� BLOCK of <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORII'v 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,�WAAC /) <br />�� <br />'GNATUPC <br />PROJECT ADDRESS <br />/ S T t�/ <br />` r i-- <br />TE <br />CITY BUSINESS <br />ROSINESS LICENSE . <br />- <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 (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />I <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />, <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />; <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />; <br />( <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />, <br />EXHAUST FAN <br />, <br />SINK (SERVICE —BAR, ETC.) <br />, <br />, <br />, <br />, <br />, <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />, <br />PERMIT $ <br />i <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />L <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />i <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONiT. ACTUAL <br />OGWPANLT <br />CRIMP <br />NO.MMULINGUNII6 <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />AUDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REOD HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />SPRINKLER <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 />' <br />TOTAL <br />