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r1c. <br />u ' <br />L. <br />�Aw <br />APPLICATIC I FOR CONSTRUCT )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATINGSYSTFId JGAS JLIfCIRIC J <br />BUILDING DEPARTMENT <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL A:WREBS ,..T '41NE <br />-Wl�-Wb COMMffCIAL 41PAIA—Nt E-D �� j757Pt. PHONE <br />> FZ 1 <br />TENANT MAIL A.AREBB <br />ITY <br />ARCHRFCT OR DESIGNER MAIL ARESS CITY 2iP PHONE <br />DD <br />ACTOR MAIL APDRESS <br />w L-Iy W I4 _ IO* <br />PIUMBNO CONTi <br />CLASS OF WORK <br />PHONE <br />T <br />pIIL70, <br />LI ENSE F <br />nnu wMr%QTC1V96PPl INSERT BUILDING RELOCATION <br />0 NEW ADDITION ALItnAllvry -- -- <br />-- <br />CONTACT PERSON AND PHONE NO. <br />DxN N A C4 BRA I_ & 73 -7G71< <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />FQEESfAND/Nb NON ILLUM/tLATI< ` r $ <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />PROPOSED USE :>F BUILDING <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 SPECB"IED HEREIN OR <br />IEMIDESCRIPIgN OF PROPERTY ItR10Y/T/BELOW OR ATTACH FOUR COPIES <br />of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRIEST IME TO GIVE <br />LOT BLOCK <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 />p <br />d 0 _ _ O� _ vQ <br />It <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x <br />fT <br />----- <br />PROJECT ADDRESS <br />WA- <br />/.•if <br />491K[AY M <br />MECHANICAL <br />PLUMBING <br />N0. TYPE OF FIATURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILEn <br />AJC—AMNDLG UNIiS—H.P, <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNITHEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />_ <br />SHOWER <br />VENTILATION FAN <br />_ <br />KITCHEN SINK 8 DISP <br />_ <br />DISHWASHER <br />RANGE HOOD <br />WATER HEATER <br />LAUNDRY TRAY <br />WOOD STOVE <br />— <br />CLOTHES WASHER <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />- <br />1 <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL f <br />SUBTOTAL f <br />PERMIT f <br />PERMIT <br />TOTAL FEE f <br />TOTAL FEE $ <br />FOR OFFICE USt <br />ONLY: <br />RECEIPTNo <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK4PBER / FEE ' <br />VACANT SITE <br />FEES/!!VALUATION <br />FEE <br />USE lOIE'' <br />LOT AREA <br />1 � <br />BUILDING <br />TYN O CONIS ALLOWABLE <br />MCOSI ACIUAI <br />An MtM'l1I�A4 uxn <br />PLUMBING <br />-� <br />MECHANICAL <br />512E CF B100 <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />i <br />' <br />OCCUPANCY LOAD FIRE SPRINKLERS PEOD HEgNT lIM11AilON <br />� <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />' J <br />REASON FOR SPRINKLERS <br />PUBLIC WORKS <br />INTAKE BY <br />Pu <br />A PROVEDBY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TGTAL <br />/3 ;(jam <br />