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APPLICATION FOR CONSTRUCTION PERMIT <br />r", L ,,.,0 v TO BE COMPLETED IN INK —PLEASE PRINT <br />clry ofXvi <br />eve re: ❑ ELECTRIC U _ 1 <br />BUILDING DEPARTMENT ARTMENT LHEATING SYSTEMU GAS J <br />259-8810 <br />DEMOLITION COMBINATION BUILDING >4ECHANICAL PLUMBING SIGN <br />WNER n MAIL ADORES B �7 CITY % ZIP PHONE -- <br />I',In��S <br />DESIGNER <br />MAIL ADDRESS <br />ZIP PHONE <br />ZIP PHONE <br />PLUMBING CONTRACTOR MAIL ADDRFSS Cal 0M) <br />CITY ZIP PHONE LICENSE <br />CLASS OF WORK �/ _ <br />NEW ! ADDITION ✓ALTERATION - REPAIR DEMOLITION ! WOODSTOVE/FRPL INSERT ,.. BUILDING RELOCATION <br />CONTRACT PRICE OF WOR <br />,.r.v r.,sAvc nu. <br />DESCRIBE WORK AND SQUARE F TAGE INVOLVED <br />=nsln _U <br />PROPOSED USE O< BUILDING <br />E <br />I 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 GOVER14ING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY )SHOWN BELOW OR ATTA Al FOUR COPIES) <br />LOT BLOCK or <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />- <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE U, ':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 296,200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />l I /i, <br />PROJECT AD^DR�E. S'S <br />,�., <br />( <br />�•/Ji�"= <br />APPLICANTS C17Y BUSINESS LICENSE NO ANDBUSINESSNAME <br />--J/ 'S ' Y / — <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENTSFEEWATER <br />CLOSET (TOILET) <br />ATC-A/HNDLG UNITS-H. P.BATHTUB <br />' <br />FORCED AIR SYSTEMS-BTUI <br />AVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. MSHOWERCLOTHES DRYERSKITCHEN <br />SINK d DISPVENTILATION <br />FANDISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />, ' <br />WATER HEATER <br />, <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />) <br />URINAL <br />' <br />, <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />�— <br />' <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />—�— <br />, <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />I <br />ROOF DRAINS-RAINLEADERS <br />, <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />I ' <br />I <br />; <br />I <br />' <br />) <br />SUB TOTAL E <br />SUB TOTAL S <br />PERMIT E <br />I <br />PERMIT E <br />/ F <br />TOTAL FEE E <br />TOTAL FEE E <br />5-3— <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAIT CHECK NUMBER i r E I ,,.: ' iPT NC) <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />BUILDING <br />ttPF OF CONIS AIIOWpBIF <br />tYPF aCOIIST A,;fUAI <br />71CLITMYLY <br />s�ouF <br />KO MOAtulKc urns <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMEN', <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REED HEQHT LIMITATION <br />REASON FOR SPRINKLERSOTHER <br />INTAKE BY PLAN%APPROVED BY CITY OF EVERETT <br />T LOCAL SALES <br />TAX CODE IS 3105 <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />► -Tvilure12: <br />