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A APPLICATI(rl FOR CONSTRUCZ _ON PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ <br />259-8810 <br />DEMOLITION COMBINATION BUILDING kMECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY 21P 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 <br />STATE LICENSE <br />94-4r¢-p4 <br />2603 fits lr>dUL <br />qrA <br />aL22<xo <br />2,�3 -1-14 <br />�Sr/ w�7Rd <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE# <br />r <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE IT <br />ICL,ASS OF WORK <br />:x NEW - ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />dr A 2 TT <br />CONTRACT PRICE OF WORN iJ�V <br />CONTACT PERSON AND PHONE NO. <br />C C I <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />2 E-!Z kIR <br />(�z <br />PR OSED USE OF BUILDING <br />V —� (_2 <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 CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAWW 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 />CONT TORS LAW 18.27 RCW AND 296.200 WAG. <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OE <br />L ? �' <br />�_/ L <br />— <br />PROJECT ADDRESS <br />51GNAiu E on <br />CITY BUSINESS LICENSE NO <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 />AIC-ATHNDLG UNITS-H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I <br />I <br />I <br />I <br />I <br />SUBTOTAL $ <br />SUBTOTAL $ <br />J <br />PERMIT $ <br />PERMIT $ <br />/ <br />TOTAL FEE $ <br />T <br />TOTAL FEE $ <br />FAR nFFICF IIRF nNl V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECn NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />BCCUPANGY <br />NO OF MELLING UNITS <br />I <br />teaur <br />PLUMBING <br />i <br />SIZE OF BLDG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />30� <br />_ <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />SPRINKLER <br />I <br />REASON FOR SPRINKLERS <br />�- <br />STATE BUILDING SURCHARGE <br />INTAKE By <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />S ; <br />