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APPLICATION FOR CONSTRUCT. JN PERMIT cYeTe'1 <br />FRIEmroloon TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF ue <br />everett HEATING SYSTEM: U GAS (DIELECTRIC U ._ _ <br />BUILDING DEPARTMENT -- <br />259•8810 <br />DEMOLITION I I COMBINATION BUILDING I I MECHANICAL i i PLUMBING SIGN <br />O E MAILADlInllS n w `CITY ZIP ?�/PyIKNE o7 <br />ENANT�W I/ MZ AIL^ OJ 5 D / A• / r'� /I REI CITY ZIP PHONE <br />ARCHITECTOR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PHONE LICENSE I <br />MAN ADDRESS CITY ZIP PHONE I ICENSE I <br />.. i iA A Av ? <br />MAIL ADDRESS <br />CITY ZIP <br />I ICENSE <br />2- <br />CLASS OF WORK <br />I I uFw I I AnnITIFIN I I A[TFRATION I I REPAIR DEMOLITION I I WOODSTOVEIFRPLINSERT I I BUILDING RELOCATION <br />Lou <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK Z CIU <br />ESCRISE WORK AND SQUARE FOOTAGE INVOLVED <br />iJKC 6.1 Zo ff /n✓1_ <br />PnoPOBED USE OF OUNDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />S� h </I <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS ANn ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESERIPT PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLE(ED WITH WHETHER SPECIFIED HEREIN OR <br />LOT_ BLOCK OF <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 LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OFFCONTRACTOR OR AUTHORIZED AGENT DATE <br />f� / - -- <br />AND BUSINESS NAVE <br />PROJECT ADDRESS <br />APPIKANTSC1iYBUSINE IICENBENO <br />PLUMBING IFYa <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 />A/C-A/HNDLG UNITS-H.P. <br />I <br />BATHTUB <br />if <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 />) <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />1 <br />URINAL <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />, <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />) <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />_ <br />' <br />EXHAUSTFAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />' <br />I <br />' <br />I <br />SUB TOTAL <br />S <br />; <br />SUB TOTAL E <br />PERMIT <br />$ <br />PERMIT $ <br />, <br />TOTAL FEE <br />$1 <br />TOTAL FEE $ <br />t <br />cne ncclF•c ucc nul Y: <br />FRONT SETBACK <br />FIEARSE713ACK <br />SIDE SE TBACN <br />PL AN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />TYPE Of CONTS AILOWAIR E <br />TYPE OF CONST ACTUAL <br />MCi <br />mmmiIMNOIS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS REOU <br />HEIGHT LIMITATION <br />, <br />OTHER <br />REASON FOR SPRINKLERS <br />—�—�� <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />I <br />LOCAL SALES <br />— <br />TAX CODE IS 3105 <br />TOTAL <br />