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APPLICATW-N FOR CONSTRUCT 3N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE: PHINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS C ELECTRIC J <br />259-8810 --- <br />DEMOLITION <br />COMBINATION_ X BUILDING <br />MECHANICAL PLUMBING SIGN <br />OVAIER <br />MAIL AODREES <br />CITY <br />— <br />Z/ylyP'] <br />t'"1E .1 <br />�� ifN <br />,,II <br />IN <br />(,� _ <br />I IDl� <br />_(ill <br />TE <br />MAIL ADOR <br />CITY <br />.P�lR.Of�NLE�✓� 7V <br />ZIP PHONE <br />CRY <br />Z" PHONE <br />ARCHRECT OR DESIGNER <br />MAIL ADDRESS <br />G��EI AL CO`)N''T�RACTOR <br />MAR ADDRESS <br />CIT,Y�n <br />Z P PHONE STATE LICENSE / <br />C.��C 1D1�5%RtG�o,A� <br />MECHANICAL CONTRACTOR <br />5 <br />I%1 <br />MAIL ADDRESS <br />/ <br />/ IML'�SuILLE' <br />CITY <br />_ <br />�lirl%� (r;1'/2?7 OK 31KL <br />ZIP PHONE STATEL EASE If <br />PLUMBING CONTRACTOR <br />ZIP PHONE STATELICENSEN <br />MAR ADDRESS <br />CITY <br />NEW ADDITION YALTrzRATION REPAIR i- OEAIOOLTMN wnnneTnMCICODI IMCCOT e,III nIkI..,�....a,.,.. <br />0A / ' / <br />CONTRACT PRICE OF' WORK �Q S�oL- �IJ. 1 dD <br />DESCRIBE WORK AND SOUARE F TAGE INVOLVED <br />/,—� <br />Pnti ! Lil(0 'AL <br />C <br />ACT PERSON AND PHONE NO, <br />^, <br />r N� �7 <br />f Q� <br />PROPO OUSE'9F B"UILDI,N,O <br />ASt( -k <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 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 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 />CONTRA 37TRS LAW .27 RCW AND 296,200 WAC. <br />X <br />LEGAL DE RIPTION OF PROPERTY ISHOWN BELOW OR AT IACH FOUR COPIES) <br />LOT_ BLOCK OF <br />1 �` O , ^u��^• ` <br />sl ^' JfU 41fl7 <br />IL105 ?3r1 <br />/,E <br />PROJECT ADDRESS <br />scw. DATE <br />CpV ptlSi FSS Vf!NSI Wl <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) _ <br />I <br />A1C—AIHNDLG UNITS—H.P. <br />, <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />I <br />LAVATORY (WASH BASIN) <br />, <br />UNIT HEATERS—B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />' <br />DISHWASHER <br />I <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />METAL FIREPLALE 8 CHIMNEY <br />-- �— <br />DRINKING FOUNTAIN <br />; <br />LA <br />FIREPLACE INSERT <br />FLOOR DRAIN _ <br />HEAT PUMP__ <br />T— <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />, <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />; <br />SUB TO Al <br />PERMIT S <br />TOTAL FEE S <br />TOTAL EE $ <br />�— <br />FOR OFFICE USE ONLY: J" _ f •,' <br />FRONT SETBACK <br />RF 1R SETBACK <br />SIDL SETBACK <br />PI AN CHy: K NUMBER <br />FEE 'R•r <br />REC T NO. <br />1 <br />USE ZONE <br />-- _1 <br />LOT AREA 'S <br />VACANT SITE <br />0 <br />FEES <br />VALUATION <br />_ <br />FEE <br />BUILDING <br />YAO <br />TYPE OFCONIS ALLOWMAE <br />7,_ <br />TYPE Of CONST ACTUAL <br />OCCUNNCY <br />gdmit"'MAPS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOM FIRE SPRNKLERS REDO HEIGHT LIMITATION <br />A <br />V:ASON FOR SPRINKLERS <br />SPRINKLER <br />i <br />' <br />STATE BUILDING SURCHARGE <br />5z, <br />WAKE SY <br />PUNS APPROVED BY <br />,J 223 <br />1 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />_—A•-- <br />TOTAL <br />35 <br />