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APPLICATIO A FOR CONSTRUCT►' N PERMIT everett <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> Ihn(vrrprrn <br /> CITY or <br /> everett HEATING SYSTEM: ;OQAS UELECTRIC ❑ _ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I I DEMOLITIrN I I COMBINATION 11 BUILDING )4MECHANICAL PLUMBING ❑ SIGN <br /> IWO r MAIL ADDRESS CITY IIP PHONE <br /> [���I/CJ <br /> IF-NANT zlr Pl"JESJB �ncSEcEr 3yZ <br /> J�a*MDnEsZ <br /> r <br /> PHONE <br /> MICIIItrcT On0E41GNER MAIL ADDRESS <br /> CITY ZIP <br /> GFNEMLCONTMpOR MAIL ADDRESS CITY ZIP PHONE LICENSFI <br /> LICENSE <br /> MECHANICAL COrII nACIon MAI ADOBESS CITY IIP PHONE <br /> s�iez✓ f�� <�� � �✓ rnvk 9�7s' �s3-J�/y S�vi�o�s'o� <br /> PLUMBING CONTRACTOR MAA ADDRESS <br /> CITY IIP PROVE LICENSE F <br /> ' CtASS OF WORK �l.,.�"' <br /> I NEW I i ADDITION yc,Q(JEHAI ION I I REPAIR I I DEMOLI110N I I WOOOSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br /> CONTACT PERSON AND PHDNE NO. <br /> Id CD <br /> CONTRACT PRICE OF WORK <br /> ZENnK AND AND SU)ARE FOOTAG NVOLVED <br /> PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ���J APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> lEOAL DESCRIPr10N OF Pn01'EBTV IsNom BELOW OR AoAC1T FOUR r.OPIE4) 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 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 STATL <br /> CONTRACTORS LAW 18.27 RCW AND 288.200 WAC. <br /> SIGNATURE OF CONTRACTOR On AUTHORIZED AGENT DATE <br /> PROJECT ADDRESS �Cs� APPLICAM s SS IICENSEN AND BMSINES4 NAME <br /> ZS7S' 8" <br /> PLUMBING MECHANICAL <br /> FEE NO. TYPE OF EQUIPMENT FEE <br /> N0. TYPE OF FIXTURE OR ITEM A1C7NHNDLG UNITS—H.P. <br /> WATER CLOSET(TOILET) <br /> BATHTUB <br /> ' FORCED Ain SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M <br /> T <br /> SHOWER _ ' CLOTHES DRYERS <br /> ' VENTILATION FAN _ <br /> KITCHEN SINK 8 DISP ' <br /> RANGE HOOD ' — <br /> DISHWASHER I <br /> WATER HEATER <br /> LAUNDRY TRAY <br /> CLOTHES WASHER �— WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN ' <br /> FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP <br /> ' <br /> BACKFLOW PREVENTERS 1 GAS PIPING <br /> _ ROOF DRAINS—RAINLEADERS <br /> 1 EXHAUST IAN ' <br /> SINK(SERVICE—BAR ETC.) — 1 <br /> 1 <br /> _ 1 1 <br /> 1 _ <br /> I <br /> SUB TOTAL $ <br /> ' SUD TOTAL f 3D F_ <br /> � PERMIT f /S ' <br /> PERMIT f 1 TOTAL FEE f - <br /> - TOTAL FEE S <br /> FOR OFFICE USE ONLY: RECEIPT NO <br /> FRONT SETBACK PEAR SETBACK 410F.SFiP.ACN PLAN CHECK NUMBER <br /> FEE <br /> USE.ZONE <br /> LOT AneA vACANT nne FEES VALUATION FEE <br /> BUILDING <br /> TYP(o1 CDNIS At I OWMH F rYPI Or CONST ACIUM OM A'IW, OMPMIIMOMMF PLUMBING ' <br /> SIZE OF BLDG NO NO OF STORIES BASEMENT MECHANICAL <br /> OCCUPANCY LOAD FIRE SPRNNLERSTIEOD HEIGNI LIMITATION <br /> ADDITIONAL PLAN CHECK <br /> OTHER <br /> nEAsoN Fon srnINKLEns <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANSAPPRGYEDBY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES i <br /> TAX CODE IS 3105 TOTAL 1 <br />