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n <br />c :, <br />1 <br />APPLICATIOL FOR CONS'rRUCTI N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM 'A GAS U ELECTRIC J ----- <br />BUILDING DEPARTMENT <br />259 8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />GENERAL CONTRACTOR MAR ADDRFSS CITY ZIP PHONE STATE .ICENSE4 <br />MECHANICAL CONTRACTOR MAIL ADORLSS CITY ZIP PHONE STATE LI;ENSE0 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE '.I;ENSEI <br />CUSS OF WORK <br />As ...­..... .I I ... TInAI aFGAIa nFMOI ITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF PORN Jp <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUKOIO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 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 />AUTHORIT! 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 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC Xx <br />LEOAL DESCRIPTION OF PROPERTY I SHOWN BELOW OR AT TACH FOUR COPIES) <br />LOT_ BLOCK OF <br />- <br />PRWEC7 AR,D11RESS <br />/�5v llO of..) u <br />t <br />Srt Alu'.I LATE <br />1T-v 11- . -- <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 />AIC-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-ELTU. M E.A. <br />LAVATORY (WPSH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK S DISP <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />OAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE- AR. ETC.) <br />c J <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />r- <br />PERMIT $ <br />_ <br />TOTAL FEE S <br />TOTALFEE $ <br />cnn necEne uae nw v. <br />FRONT SETBACK <br />REAR SETBACK <br />6WE 6CTBACK <br />PUNCl/CCK NUMPER <br />EFC <br />RECEIPT NG <br />� n <br />USE ZONE <br />LOE AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE OF CONIS AlLOWANI <br />TYPE M CMSI ACTUAL <br />GLfIKVA[.- <br />4A°'� <br />SIZE OF BLDG <br />NO, OF STORIES <br />BASCMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />- _ <br />I <br />OCCUPANCYLOAD FIRE SPARKLERS REGO <br />HEIGHT LIMITATION <br />SPRINKLER <br />I <br />r— <br />REASON FOR SPRINKLERS <br />CITY OF EVERETT <br />STATE tWILDING SURC14ARGE <br />INTAKE BY <br />PLANB APPRoveoer <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />