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,30tl <br />im40 <br />yHp�tHi� <br />to <br />K n <br />H �l <br />Qmo <br />y o <br />O11 <br />11 <br />O�1 H�y <br />H t*JQ <br />t" F3 <br />HH <br />8CA <br />H <br />C] lC7 f[[/-+rI <br />E3 h <br />r3 O En <br />APPLICATIGA FOR CONSTRUCT JN PERMIT <br />rNAEroryTO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: O GAS 0 ELECTRIC U _ <br />BUILDING DEPARTMENT <br />259.8810 <br />,}7 I DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBO�G SIGN <br />LAB ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DE5gNER <br />MAII ADDRESS <br />CITY <br />ZIP PHONE <br />CITY <br />ZIP PHONE LICENSE P <br />GENERAL CONTRACTOR <br />MAIL ADDREb9 <br />CITY <br />ZIP PHONE tKENSEF <br />MECHANICAL CONTRACTOR <br />MAR ADDRESS <br />MIIMRBKLCONTRACTOR <br />♦ MAR ADDRESS <br />CI L <br />PHONE IICENSE F <br />/ TIP /f ^. <br />FciAss o<woRK r.cAfnl ITVYM wnnn3TnVFJFRPL INSERT BUILDING RELOCATION <br />NEW ADDITION I ALlcnnnVlY - <br />-- '--" <br />-- <br />CONTACT PERSON AND PHONE NO <br />C(N/TRACT PRICE OF WORK <br />DESCRIBE WORK AND SOVARE 1—IKLIEI VEO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USEOF BUILDING <br />/ <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />ii c <br />'"IOf <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />IFOAI DE A!s .i.. �^ <br />PROPERTY (SHOWN BELOW OR ATTACHfOURCOPIESI <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />TOT BLOCK of <br />- <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 1 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 LAW 18.27 RCW AND 296.200 WAC. <br />SIONATUREOP RA TOR ON AUNT DATE <br />X <br />PnnJ[c I ADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. MO SIUSINESS NAME <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />OF FIXTURE OR ITEM <br />T (TOILET)A/C—A/HNDLG <br />UNITS—H.P.ORCED <br />WPLUMBING <br />AIR SYSTEMS—B.T.U. M E.A.ASH <br />UNIT HEATERS—B.T.U. M <br />BASIN) <br />I <br />CLOTHES DRYERS <br />i <br />VENTILATION FAN <br />8 DISP <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />i <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />�— <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW P13EVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR. ETC.) <br />I <br />' <br />SUBTOTAL $ <br />SUBTOTAL $ <br />' <br />PERMIT S <br />PERMIT $ <br />I <br />TOTAL FEE $ <br />TOTAL FEE S <br />' <br />FOR OFFILA: uSC <br />V17LT: <br />RECEIPT NO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN LNFf.K NUMBER <br />III <br />AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />LOT <br />BUILDING <br />-- <br />TYR OF CONTS Al10WA6 <br />TYPE TM CONS) AC1UAl <br />aLT r <br />Mn tlNRU114 W+a <br />PLUMBING <br />MECHANICAL <br />_ <br />SRE OF BLDO NO OF STORIES BASEMENT <br />ADDITIONAL PUN CHECK <br />i <br />I <br />OCCUPANCY LOAD FIDE SPRNKLERS REOD HEIGHT IIMIUIgfI <br />i <br />OTHER <br />STATE BUILDING SURCHARGE <br />REASON FOR SPRNKLERS <br />PUBLIC WORKS <br />I <br />NTAKESY PLANSAPPROVEDBY CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />