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APPLICATIC A FOR CONSTRUCT- IN <br />TO BE COMPLETED IN BLACK INK --PLEASE PRINT <br />PERMIT �. <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />i DEMOLITION COMBINATION BUILDING "ECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />sa<",,,� ---- <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITE ORDESIGNER MAl ADDRESS CITY ZIP PHONE <br />E&(Lrj sdtA i &2u.. mo nt; kely>? Casa as-,�2�0 —. <br />DENER; _ CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE �gT,6223?Ii ENSEI <br />PLUMPING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSES <br />CLASSCLASS OF <br />NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRFL INSERT BUILDING RELOCATION <br />% <br />CONTRACT PRICE OF WORK � l(/ G— O U <br />CONTACT PERSON AND RHO <br />O CRIBE WORK AND SOU RE TTAGE INV6LVEID n <br />Pnopbs EOF BUILD NG <br />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 RRCCWW AND 296.200 WAC. <br />X v <br />ATE <br />) / — o <br />LEGAL DESCRIPTION Or PROPERTY SHOWNAELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK __ of <br />'J <br />IJ- -�,3 - Q -00 <br />PROJECT ADDRESS <br />CITY BUSINESS LICENSE Nn <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 />A/C-A/HNDLG UNITS-H.P. <br />_ <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 />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />; <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />— <br />r— <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />i <br />ROOF DRAINS-RAINLFADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. HTO.) <br />SUBTOTAL S <br />SUB TOTAL $ <br />Aj�o <br />PERMIT 3 <br />PERMIT 5 <br />TOTAL FEE $ <br />TOTAL FEE $ <br />rnn nF;FICF I IRE CINI V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RE SEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- — <br />TVE OF CONTS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />OCCUPANCY NO Of OwFLIINS uxn$ <br />cBouP <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIIAITATIDN <br />SPRINKLER <br />i <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLICWORKS <br />LOCALALES <br />TAX CODE 13 3105 <br />TOTAL <br />