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APPLICATION FOR CONSTRUCiI.ION PERMIT i <br />the uw gwn TO BE COMPLETED IN INK -PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM; \GAS LI ELECTRIC U <br />BUILDING DEPARTMENT <br />259.8810 <br />1 1 DEMOLITION <br />I COMBINATION <br />BUILDING <br />MECHANICAL <br />PLUMBING C.GN <br />ER ` <br />MAC ADDN 33 _ <br />CITY <br />I PHONEll.. S-76 <br />TENANT\ <br />MAR ADDRESS <br />CITY <br />ZIP PHONE <br />.....././�\.}.(..n..cc�-�cn <br />uAu AnnnFRR <br />CITY <br />ZIP PHONE <br />CLASS OF WORK �/ <br />I I mew I I AnnITInM M AI TFNATInM I I REPAIR I I DEMOLITION I I WOODSTOVEIFRPL INSERT I i BUILDING RELOCATION <br />VVI <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORN <br />DESCRIB K A AR F TAGE INVOLVED • _ <br />1pS/A/ <br />PROPOSED USE OF BUILDING <br />1 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 />LEGAL DESCRIPTION OF PROPERTY ISK)WN BELOW OR ATTACH FOUR COPIESI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK OF <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 RCW AND 296,200 WAC. <br />SIGNATUREOF CONTRACTOROR AUTHORIZED AGENT DATE <br />_�--�5/ C 5 l dtp/n/�' <br />� <br />APPI If.ANi6 CITY 0U31NE 9lICEN3E NO AND 8U31NE35 NAME <br />PROJECT ADDRESS /_ ("'I <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPEOFEOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />A,C--NHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T. E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />I <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />_ <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE A CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />I <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />_ <br />BACKFLOW PREVENTERS <br />OAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR. ETC.) <br />' <br />I <br />� <br />I <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />I <br />TOTALFEE $ <br />' <br />TOTAL FEE S <br />J ' <br />w Ar19/�C I IQC Flu <br />. <br />FRONT SETBACK <br />•REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />r <br />TYPI OF CONTS ALLOWAIII E <br />TYPE OF CONST ACTUAL <br />i <br />WM M'Ilw wR <br />PLUMBING <br />i <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />r <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD <br />HEIGHT LIMITATION <br />OTHER <br />i <br />I <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />1 <br />PUBLIC WORKS <br />1 <br />INTAKE BY PLANs.Fr 1GVF0 Fly <br />CITY OF EVEREI'T <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />— <br />JrS i <br />I <br />