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APPLICATIO., FOR CONSTRUCTL aN PERMIT <br /> EnPE �R TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS J ELECTRIC U <br /> a 259.8810 NwKaAI <br /> 1 DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGNS <br /> OWNER MAR ADDRESS CITY ITP PHONE <br /> S5''c�- <br /> TENANT �D11ESS CITY ZIP %NONE <br /> ARCHITECT CR DESIGNER MAR ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR CITY TIP PHONE LICENSE A <br /> -�. <br /> Hwp�l MECHANICAL CONTRACTOR MAIL ADDRESS CITY DP PRUNE LICENSE <br /> •'+ �� PLUMBIIIGCOIRACTOR MAI ADDRESS CITY ZIP PHONE LICENSE <br /> IOEa <br /> C H CLASS OF WORK 4 <br /> H NEW ADDITION ALTERATION A,"EFAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> ON CONTACT PERSAND PHONE NO <br /> ,3 /J <br /> CONTRACT PRICE OF WORK <br /> DESCRIBE WOW AND SQUARE FOOTAGE INVOLVE`D 7 7� 7 <br /> x yOK 'IRROPOSE�E�� �O ♦ '%PAecWlTE 1 HEREBY CERTIFY THAT I Ht/E READ AND EXAMINED THIS <br /> LO H APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> COQ U <br /> H ��yy LEGAL DESCRIPTN OF PROPERTY ISHOAN BELOW OR ATTACH FOUR COPWSI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> N 0 O WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> G1Lor• 0 BLOCK a NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> _ AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> "' S•E • OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> H PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> & l�E��TI• W� ��3 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> L7 CHir ♦ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> t] C y CONTRACTORS LAW 18.27 RCW AND 298.200 WAC, <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> �caPROJECT ADDRESS <br /> toi _ X <br /> 4PPLICANTSCItY BUSINESS LICEN OIJIDBUSNESSN/YE <br /> PLUMBING !' MECHANICAL <br /> I NO. TYPE OF FIXTURE OR REM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AtC­AMNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. r <br /> LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M I <br /> _ SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER — <br /> 1 CLOTHES WASHER I WOOD STOVE <br /> URINAL METAL FIREPLACE d CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEATPUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> _ ROOF DRAINS--RAINLEADERS EXHAUST FAN _ <br /> SINK(SERVICE-RAR.ETC.) I <br /> I <br /> I <br /> _ SUBTOTAL f i SUBTOTAL f _ <br /> �ca. <br /> . PERMIT f PERMI- f <br /> TOTAL FEE f TOTAL FEE f <br /> FOR OFFICE USE ONLY. <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> BUILDING <br /> TYPE OR CONIS ALIDWANE TYPI OF CONST ACTUAL OLCIINKH M6PAYH•W.15 -- -- <br /> 41pV PLUMBING ' <br /> SIZE OF BLDG NO OF STORIES BASEMENT MECHANICAL <br /> OCCUPANCY LOAD FIRE SPRNItERS REDD HEIGHT LIMITATION ADDITIONAL PUN CHECK <br /> OTHER <br /> REASONFORSPRINKLERS -- -- '- <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANSAPPROVEDBY CITY OFEVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL �I. <br />