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APPLICATIO.. FOR CONSTRUCT[ !N PERMIT Lr,'rFE'Il <br /> the E..... n TO BE COMPLETED IN INK—PLEASE PI INT <br /> CITY Of <br /> everett f HEATING SYSTEM: U GAS LECTRIC U _ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> _ DEMOLITION 54,COMBINATION BUILDING _MECHANICAL PLUMBING SIGN <br /> - - <br /> OWNER MAI(ADDRESS CITY ZIP PHONE <br /> TENANT MAIL ACTRESS CITY ZIP PHONE <br /> " <br /> APCHITSCT CR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAI(ADDRESS CITY 21P PHONE LICENSE. <br /> t — <br /> t MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> PLUMBING CONTRAC'JR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br /> ZS OF WORK <br /> EW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE <br /> NO / <br /> CONTRACT PRICE OF WORN 'JKFJ�/ tA� /+'/� �YJO <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br /> PROPOSED USE or BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � 5 ����. gsj�•,(G+� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PRC ERTY(SHOWN BELOW OR ATTACH FOUR COPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T/PE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT BLOCK OF /NE/YU+P- NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> / AUTHORITY TO VIOLATE OR CANCEL THE �ROVISIOW3 OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AN AUTHORIZED BY THE <br /> / dLC/�E GF p/9 OWNER THIS PROPERTY TO PERFORM WORK FOR WHICH <br /> I�-� APPLICATION <br /> ON IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> C/A r� ✓� / SIGNAIUNE CONTRACTOR OR AUTHORIZ DATE <br /> Gf/rts i f �i pad <br /> I PROJECT ADDRE1-07-24 <br /> ��r07 pF f(,7/ Y "�C}r7'e '•�00 <br /> dd S " ✓� � ACP CAN75 Y RUSIN SS S-N B AN / <br /> LA- <br /> PLUMBIN CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> ± WATER CLOSET(TOILET( A'C–A/HNDLG UNITS–H.P. <br /> BATHTUB FORCED AIR SYSTEMS–B.T.U. M E.A. <br /> t LAVATORY(WASH BASIN) UNIT HEATERS–B.T.U. M <br /> I` SHOWER CLOTHES DRYERS —� <br /> ` KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHIER WOOD STOVE _ <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS–RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE–BAR,ETC.) _ <br /> SUB TOTAL $ dUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FHONTSETBACK REAR SETBACKZ SIDE SETSACP PLAN CHE KNUMWy��_ff FEE _ RECEIPTN <br /> USE LONE Lor AREA VAGARY SITE FEES VALUATION FEE <br /> Z cjbX 124 A .0z BUILDING � �, / 0 <br /> YPE Of CONiS ALLOWA°LE TYPE Of CONST ACTUAL x(uNNtr NG W PATIIING UN^5 <br /> -� of ' PLUMBING <br /> SIZE OF BLpCy NO OF STORIES BASEMENT MECHANICAL <br /> IIS S F �r u <br /> OCCUPANCY AD pR FIRE SPRINKLERSREO'0 HEIGHT I IMA1ADDITIONAL PLAN CHECK i <br /> _ �+ OTHER /�! <br /> / ' <br /> Rr ASON FO S '.NKLERS 1 <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APyROVFO BY CITY OF EVERETT PUBLIC WORKS f 1 <br /> I LOCAL SALES <br /> 7 TAX CODE IS 3105 TOTAL <br /> 1 irk 93 <br />