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low <br />APPLICATIt..N FOR CONSTRUC%.ON PERM17 <br />the EwrpreeR TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: ❑ OAS ❑ ELECTRIC 0 __ <br />BUILDING DEPARTMENT <br />259•R810 <br />1_1 DEMOLITION ❑ COMF3INATION f_i BUILDING CI MECHANICAL )(PLUMBING i SIGN <br />OWNER - _ MAIL AEXIRESS CITY ZIP PRUNE <br />CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP rrgnl <br />MAIL ADDRESS CITY _ ZIP PHONE <br />❑ NEW 7 ADDITION ALTERATICN ❑ REPAIR ❑ DEMOLITION O WOODSTOVE/FRPL INSERT <br />®❑ BUILDING RELOCATION <br />T,L ,✓I caNrAcT P_ 0 P <br />.ii� - .fn�/ Nl/✓i., �� <br />DESCRIBE WORK AND SOVARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I O.WE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SANE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />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 STATE <br />CONTRACTORS W 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF AC ORORUTHOR�I/�//p+wGENT DATE <br />IVA 1 , <br />C,770 9c7 T �/.�;, .y y <br />TIiT/ 1eIe' - <br />LEGAL DESCRIPTION OF PROPERTY ISHCNAI BELOW OR ATTACH FOUR COPIES& <br />LOT— BLocK of <br />_ <br />1 & <br />PROIEGT A00 -fi4 'J <br />/���, V G <br />APPLICANTS CITY BUSINESS LICENSE NO AND19USINESS NAME <br />PLUMBING <br />MECHANICAL <br />No. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' — <br />N:,—A HNDLG UNITS—H.P.AO <br />I <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I . <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 6 DISP <br />— <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATERHEATER <br />' <br />CLOTHES WASHER <br />& <br />WOOD STOVE <br />i <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />& <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />13ACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />I <br />I <br />I <br />' <br />SUBTOTAL $ <br />— <br />SUBTOTAL f <br />' <br />PERMIT f <br />' — <br />PERMIT f <br />I <br />TOTAL FEE $ <br />TOTAL FEE f <br />' <br />Cnc ncclrc I14c nmi V. <br />FR)NTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />III <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE _T <br />BUILDING <br />- -- ---- <br />i <br />IYK Of CONIS Al IOWMh E <br />TYPI OF CONST ACWAI <br />auwxY <br />AU daMGa6 WIL <br />610°' <br />PLUMBING <br />i ^ <br />SIZEOFBLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />-& <br />ADDITIONAL PLAN CHECK <br />-E <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHTIILEITATION <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PIAHfi APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />TOTAL <br />, <br />TAJ(CODE IS 3105 <br />:1 1 <br />