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IT <br />I•crmtt <br />APPLICATYOi4 FOR CONSTRUCT► jN PERMIT n <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />fPo L, mgmrn <br />CII V OP <br />everett <br />HEATING SYSTEM: U GAS U ELECTRIC U _ _ _ - <br />BUILDING DEPARTMENT <br />259-8810 `� ' <br />DEMOLITION COMBINATION to"I UILOING nMECHANICAL PLUMBING ❑ SIGN <br />TENANT MAR ADDRESS CITY SIP PHONE <br />1 <br />CRY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY ZIP PHONE LICENSER <br />KUMBBIO CONTRACTOR MAP. ADDRESS <br />r,nn,^uc6RD1 IMSPRT fl BUILDING RELOCATION <br />❑ NEW ADDITION ALTERATION <br />J ncrnln ��•••--•------ <br />411) <br />CONTACT PERSON AND PHONE ND <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />OU <br />I HAVEDAND EXAMIN ED THIS <br />EousE a euROINa <br />APPLICATION ANDIFY KNOW THE SAME TO BETHAT <br />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 />LEGAL DESCRIPTION OF PROPERTY ISNOWN BELOWOR ATTACH FWRCOPff51 <br />NOT. TH,: GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />AUTHORITY <br />OTHER SIATE OR LOCAL LAW REGUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION.LATHAT II 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 />RRR OR AUTHORIZED AGENT DATE <br />SIGNATURE OF CONTRACTOR <br />�1 <br />ADORE /� <br />�� ( E <br />Vl'`7/- <br />APKIC <br />TS CITY BUSINESS IKI:NSE NO ANDBUMESSNAME <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO' <br />TYPE OF ENT FEE. <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />A/C—A/HNDLG UNITS—H.P. <br />WATER CLOSET(TOILET) <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M ' <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />RANGE HOOD <br />_ <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />I <br />' <br />WATER HEATER <br />WOOD STOVE �— <br />METAL FIREPLACE d CHIMNEY <br />URINAL <br />FIREPLACE INSERT — <br />DRINKING FOUNTAIN <br />' <br />HEAT PUMP <br />FLOOR DRAIN <br />i <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />T <br />SUBTOTAL f <br />SUBTOTAL <br />f <br />PERMIT f <br />PERMIT <br />f <br />TOTAL FEE <br />TOTALFEE <br />f <br />FOR OFFICE USE <br />FRONT SETBACK <br />ONLY: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />BUILDING <br />TIK O CONIS AUGINABLE <br />TYPE OF CONSI ACTUAL <br />ouw+An <br />G" <br />Aa nIIMIIALIAns <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDO <br />OCCUPANCY LOAD <br />NO OF STORIES <br />FIRE SPRNKLERS READ <br />PLANS APPROVED BY <br />SASEMCNT <br />HEIGHT UMTlATION <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />REASON FOR SPRINKLERS <br />INTAKE BY <br />err <br />`'ITMDFEVERCIR <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />