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APPLICAT16d FOR CONSTRUC7 .ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ --1 <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL I PLUMBING SIGN <br /> OrWrNER MAIL ADDRESS CITY ZIP PHONE <br /> l� iyl/ ><<i, s(c� /� y� 7 —Gml✓. /Gfssl:Z4v °�$17C— 7�5� 6`t/If <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> ,SL�..Ict <w s o <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> MECHANICAL <br /> CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE/ <br /> PLUMBING CONTRACTOR MAIL ADDRESS CRY ZIP PHONE STATE LICENSEE <br /> A�jL�A�SS OF WORK <br /> NEW I ADDITION ALTERATION REPAIR I I DEMOLITION WOODSTOVEtFRPL INSERT BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO. <br /> CONTRACT PRICE OF WORK <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br /> PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOWOR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT BLOCK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR C,5NCEL 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 /> CONTRACT/RS LAW 18.27 RCW AND 298.200 WAC, <br /> PROJECT ADDRESS <br /> SIGNATURE RUL <br /> CITY 8USMF5S LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET( AIC—AIHNDLG U14ITS—H.P. <br /> BATHTUB i--,P FORCED AIR SYSTEMS—B.T.U. M E.A. I <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> _ SHOWER C— CLOTHES DRYERS 1 <br /> KITCHEN SINK 8 DISP L VENTILATION FAN I <br /> DISHWASHER v RANGE HOOD. <br /> 1 <br /> LAUNDRY TRAY ' /--_2j WATER HEATER I <br /> CLOTFIES WASHER WOOD STOVE ' <br /> URINAL METAL FIREPLACE 8 CHIMNEY I <br /> DRINKING FOUNTAIN /i FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP �— <br /> BACKFLOW PREVENTERS GAS PIPING 1 <br /> ROOF DRAINS—RAINLEADERS Ae EXHAUST FAN 1 <br /> SINK(SERVICE—BAR,ETC.( 1 <br /> � — <br /> I <br /> I <br /> I <br /> T— <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ ; <br /> TOTAL FEE S TOTALFEE $ / I <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO <br /> J0 /09 <br /> USEZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> BUILDING <br /> TYPE OF CONTS ALLOWABLE TYPE OF CONST ACTUAL ORUMNO ENI wmloh:uBn5 - <br /> cAav PLUMBING <br /> SIZE OF BLDG NO OF STORIES BASEMENT MECHANICAL <br /> ado <br /> OCCUPANCY LOAD FIRE SPRNKLERS REOD NEgNT LIMITATION ADDITIONAL PLAN CHECK i <br /> SPRINKLER <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS I <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL Iry <br />