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n ' APPLICATIG J FOR CONSTRUCT . JN PERMIT <br /> e, TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> i <br /> BUILDING DEPARTMENT HEATING SYSTEM: y GAS ❑ELECTRIC ❑ <br /> 259-8810 *r <br /> DEMOLITION COMBINATION BUILDING ECHANICAL PLUMBING SIGN <br /> UIRL—­ <br /> MAIL ADDRESS _ CITYPHONE <br /> T " <br /> MAIL ADDRESS CRY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP�Z,p <br /> ��Q SPHONE 1 IP <br /> �STTAATE LIICC�E�NNSSEESSw/_ OMAI <br /> _ ECHA^AL CONTgA TOR A R B ��� / ,/C C' Pnh�Q :'73�4(II /�UL(TG' NOCEF�YQPLU IITRACTOR TM 'LADO LESS CU�-JI�1 OITYJV`✓G•l'J'' PHONE STATE LICENSES <br /> CLASS OF WORK <br /> i. I NEW ADDITION ALTERAT:ON REPAIR DEMOLITION WOODSTOVL RPL INSERT BUILDING RELOCATION <br /> �7T — §ONTACT PE SON AN HONE NO. <br /> CONTTIACT PRICE OF WO <br /> iDES <br /> ICFFFIC/B/E1�WORK ANDS WRE FOOTAGE IF&OLVED <br /> PROPOSEDUSE,JF BUILf`IN <br /> I HEREBY CERTIFY THAT I HAVE READ APT) EXAMINED THIS <br /> -�IO✓J��D J/) APPLICATION AND KNOW THE SAME TO BE 1 AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOT BLOCK _ OF 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 OTHER STATE OR LOCAL LAW REGULATING CONSTR CT ON OR THE <br /> PERFORMANCE OF L.ONSTRUCTION.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 290.200 WAC. <br /> vRaecrADDREss �� �` <br /> WE lMtE <br /> • ,Ifv A09419S 1.Wr N1 l NO <br /> PLUMBING _ MECHANICAL <br /> NO. I TYPE OF FIXTURE OR REM FEE ­NO-_T_ TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC-AIHNDLG UNIT H.0 , <br /> BATH TUB FORCED AIR SYSTEMS-B.TU,,"R3b&b <br /> LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS —� <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER ' RANGE HOOD -T-- <br /> LAUNDRY TRAY 7WATER HEATER <br /> CLOTHES WASHER __ WOOD STOVE <br /> URINAL METAL FIREPLACE A CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS Z GAS PIPING <br /> ROOF DRAINS-RAINLF.ADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) <br /> SUB TOTAL E ; SUB TOTAL <br /> PERMIT $ PERMIT $ /f i <br /> TOTALFEE $ 1 TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPTNO <br /> _?7-3so <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> BUILDING <br /> OF DDNlfi A40WABlF TYPE OF COxfiI ALrU4 o[LUMxO xo pfMTRNGIMnE <br /> cEauF PLUMBING i <br /> SIZE„9L06 NO OF S10rIIE3 BASEMENT �— <br /> MECHANICAL ' <br /> OCCUPANCY l0A0 FIRE SPRNKLERS REDO HEIGHT LIMITATION ADDITIONAL PLAN CHECK ' <br /> I <br /> REASON FOR SPRINKLERS SPRINKLER _ <br /> STATE BUILDING SURCHARGE ' <br /> I <br /> INTAKE BY [PLANSAPPROVEDBY CITY OF EVERETT PUBLIC WORKS i <br /> LOCAL SALES <br /> TAX CODE 18 3105 TOTAL 30 <br />