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APPLICATIO.. FOR CONSTRUCTI.jN PERMIT i <br />the Emar"n TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett FHEATING SYSTEM: U GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT — <br />259-8810 <br />I I DEMOLITION I I COMBINATION BUILDING I MECHANICAL I PLUMBING SIGN <br />�ANT Owl IT MAIL ADDRESS CITY ZIP PHONE <br />ss ���� s�� - Sal 121 L. -�; 3y �- o7so <br />TE MAIL ADDRESS I CITY ZIP PHONE <br />ARCHITECTOR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE E <br />MEC; ICALC'jHACTQRA V IL ADDRESS CITY CITY ZIP PHONE LICENSEE <br />N W T/ A/I 20,5-m N" A 163 Ry <br />.............. ..........e...e uu, CITY TIP PHONE LICENSE E <br />NEW I I ADDITION I I ALTERATION 1 1 REPAIR I I DEMOLITION I I WOODSTOV&FRPLINSERT I BUILDING RELOCATION <br />„B <br />CONTACT PERSON AND PHONE NO <br />''''jj 7 <br />ON CTRACT PRICE OF WORK ZQZF <br />01 <br />DESCRIBE WORK AND SOURE FOOT GE INVOLVED <br />PROPOSED USE OF BUT ING <br />I HEREBY CERTIFY THAT 1 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 />ICO DE RIPTION F PROPERY' ISHOWN BELOW OR ATTACH FOUR DOPIEST <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT_ OLOCK OF <br />— <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />— <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 LAW 16.27 RCW AND 296.200 WAC. <br />SIGNATURE OFCONTRACTOROR AUTHORIZED AGENT DATE <br />r4 N 1lw I/ <br />PROJECT ADDRESS <br />:I <br />l V <br />x'fl <br />APPLICANTS CITY BUSINESS) ENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />1 <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />1 <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />! <br />KITCHEN SINK 8 DISP <br />1 <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />' <br />�— <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />1 <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />AS PIPING <br />' <br />ROOc DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />' <br />' <br />T <br />- <br />I <br />' <br />� <br />1 <br />I <br />' <br />1 <br />' <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />' <br />PERMIT $ <br />1 <br />TOTAL FEE $ <br />TOTAL FEE $ <br />I.c.� � I V. <br />rvn vl . w <br />..�.• <br />FEE <br />RECEIPT NO <br />TB <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />115E ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />TYPE OF CONTE ALLOWABLE <br />TYPE O CONST. ACTUAL <br />muwKr <br />Aoduwl"iKC ImrtE <br />wlxlr <br />PLUMBING <br />� <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />I <br />I <br />OCCUPANCYLOAD FIRE SPRNKI ERB DEGO 14EIGHTLNITAYM <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />' <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED flY <br />CITY OF EVERETT <br />LOCAL SALES <br />- <br />TA% CODE IS 3105 <br />TOTAL <br />; <br />