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APPLICATIO► . FOR CONSTRUCTk jN PERMIT evL•rett <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> Irle E•vrprcen <br /> CITY OF <br /> everett Ill AlflG SYSTEM: VGAS J ELECTRIC -- <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING )CMECHANICAL PLUMBING SIGN <br /> DEMOLITION <br /> JZIP <br /> IANADDRES6y3CIfY iQ K/ /PIN/O//NCF <br /> fl , 71 1 (1 �49 <br /> Vler1 �alt CITHE <br /> Y <br /> ARCHHECI OA DESIGNdR MAK ADDRESS <br /> CITY 71P PLIDNE <br /> PEIDNNE LICENSEI <br /> GENERAL CONTRACTOR MAK ADORE 66 CITY IIP <br /> xy O H ME CHANICALCONIRACTOR MAK ADDRESS LNY IIP PHONE IICENSEA <br /> [� m , Ir►Iw,�Heativta �3��� —1�1S,L �l$Z?c7 [e99.13�D hf EQfIIj IOIb� <br /> .) w m PLWBND CCNTR TOR MA EBB <br /> CRv DP PHONE LICENSER <br /> C.'• H <br /> 7yC <br /> t' c�ulss of vronN <br /> y �IEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO <br /> pyx 5 <br /> O :L O CONTRACT PRICE OF WORK <br /> �D H �* DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br /> to H <br /> p <br /> PROroseDlNSEaDu6DNo I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Fa Cy APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> O HPROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> HIn Cy LEGALRIPTyNNOFPRO'ERTYISHOWNOELOWORATIACHFWRCOPIESI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> [�• n LOT BLOCK GF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> H AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> z <br /> z y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> t" z PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> �y H y OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> O Tn H APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> n Cy Cn CONTRACTORS LAW 18.27 ROW AND 296.200 WAC. <br /> SIGNATURE O CONTRACTOR OR AUTHORIZED AGENT DATE <br /> Fay0y X <br /> PRS" I �•y APPIIGNTB C'TV BUSNESS LICENSE NO ANp BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM <br /> FEE NO. TYPE OF EQUIPMENT FEE <br /> i WATER CLOSET(TOILET) ME,rArHNDLG UNITS—HS. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> j� LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHESORYERS <br /> KITCHEN SINK 6 DISP VENTILATION FAN <br /> DISHWASHER ' RANGE HOOD <br /> ' WATER HEATER <br /> '.AUNDRY TRAY 1 <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE f CHIMNEY <br /> FIREPLACE INSERT <br /> DRINKING FOUNTAIN ,� HEAT PUMP FLOOR DRAIN I GAS PIPING <br /> BACKFLOW PREVENTERS <br /> ROOF DRAINS—RAINLEADERS I EXHAUST FAN <br /> f SINK(SERVICE—BAR,FTC.) <br /> SUB TOTAL f SUB TOTAL f <br /> PERMIT f I PERMIT f <br /> TOTAL FEE f TOTAL FEE f <br /> FOR OFFICE USE ONLY: RECEIPT NO <br /> _ • FEE <br /> FRONT SETBACK REAR BETBACN 610E SETBACK PLAN CHECK NUMBER <br /> USE ZONE LOT AREA VACANT SITE <br /> FEES YALUATION FEE <br /> BUILDING <br /> TYPE Of CONIS ALLOWABLE IYR 01 CONS'ACIUAI nLCINYI[• An n bMUNG UIIIR ' <br /> PLUMBING ' <br /> SIZE OF BLDG NO OF STORIES BASEMENT MECHANICAL <br /> _ ADDITIONAL PLAN CHECK <br /> OCCUPANCYLOAD FIRE 6PRNNLER4 REOD NEXIHT LIMITATION <br /> OTHER <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE _ <br /> INIAKE eY PUNS APPRov[D BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES — <br /> TAX CODE IS 3105 TOTAL <br />