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APPLICATIO,4 FOR CONSTRUCTii.1N PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT F <br />E'n• h rv, ....... <br />I;ITv cI <br />everett HEATINGSYSTEAT JGAS JELECTRIC J <br />BUILDING DEPARTMENT <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER V LADDRESB CITY 71P NIONE <br />�nn11 Y M11.L. 4¢IKt%►►�; W zc`3 li's - '939y <br />TENANT WILADDRESS CITY LIP PHONE <br />PLUNBRIGCONTRACTOR <br />MAR ADDRESS <br />CITY ZIP PHONE <br />LICENSER <br />CLASS OF WGRN <br />NFw � ADDITION <br />ALTERATION <br />REPAIR DEMOLITION WOODSTOVEIFRPL INSERT <br />BUILDING RELOCATION <br />/�c / ./� <br />CONTRACT PRICE OF WORK �LJ. 1 <br />TT R AND PHONE NO <br />L J • D rr <br />DESCRIBE WORK AND SOUAAE FOOTAGE INVOLVED <br />loon , <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALI. <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 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 296.2DO WAC. <br />SKINATURE CONT%,CTORORA THORILEDAGENi JjAtE <br />� � �A" S f.L�_ <br />LEGAL DESCRIPTION OF PROPERTY)SHOWN BELOWOR ATTACH FOUR COPIES) <br />LOT BLOCK �-�— of V <br />Pnaccr ADOncss <br />^7 C CL ' I`/ <br />7 ) Y <br />APPLICANTS CITY BUSINESS LICENSE NO ANDBUSINESSNAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—ATHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />; <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILAT ON FAN <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />_ <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />_ <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />_ <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS— 1AINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />i <br />_ <br />I <br />T <br />SUBTOTAL E <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT f <br />_ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />r DONTSETBACK I REARSETRACK SIDE SETBACK PLANCHECKNIAISER FEE RECEIPT NO <br />BUILDING <br />IYP[DI MISg10WAB11 <br />IYH OI COW ALIUA: <br />FUIIIAIKr <br />p0P1Y14 AN Wr3 <br />— <br />°"°j° <br />PLUMBING <br />SIZE OF BL DO <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLFRS REGO NEIGHTLRIITAIJON <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />MANS APPROVED PY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />- �- <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I TOTAL <br />