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APPLICATIC J FOR CONSTRUCT _ JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />11EG - 4 ;q i <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: )9 GAS ❑ ELECTRIC ❑ "" .. <br />259.8810 Public Works Dept. <br />DEMOLITION COMBINATION BUILDING N41MECHANICAL PLUMBING SIGN <br />9VNER <br />MAILADDRCSS <br />IP <br />PNONE/��� <br />O <br />�C <br />- <br />1 � <br />WJ LLIIn <br />T ANT ( <br />( ADDRESS <br />CRY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CRY <br />ZIP <br />PHONE <br />V NEW I ADDITION ; ALTERATION REPAIR ' ' DEMOLITION I WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />01 O <br />CONTACT PERSON AND PHONE <br />NO <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAOC INVOLV <br />6 0 <br />PF^SEOUSEOFBURDINO <br />I HEREBY CERTIFY THAT-1HAVE READ AND EXAMINED THIS <br />MopAPPLICATION <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY(SIIONIN SELOWOR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED 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 />-- - <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />- <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />PROJECT ADDRESS <br />sK�nMunt DMF <br />�� <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />140. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />BATHTUB _ <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />A/C -A HNDLG UNITS-H.P. <br />I <br />FORCED AIR SYSTEMS-B.T.0 M E.A. <br />' <br />I <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />' <br />; <br />VENTILATION FAN <br />; <br />_ <br />DISHWASHER _ <br />' <br />RANGE HOOD <br />' <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />DRINKING FOUNTAIN _ <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />I <br />FIREPLACE IRD@Rr(i LCI&SI <br />FLOOR DRAIN _ <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />I <br />' <br />I <br />' <br />— <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />CnL] ncCV�C "cc nM1 V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />'ll <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />VALUATION <br />FEE <br />MBUILDING <br />ITYPE <br />OF CONTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />O[01MAWr <br />WOFMIIM ills <br />GSIZE <br />OF BLDG <br />NO. OF STORIES <br />BASEMENT <br />' <br />PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE SPRNKlER4 REO'D <br />HEIGHT LIMITATIONADDITIONAL <br />SPRINKLER <br />' <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />� <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />TAX CODE IS 3105 <br />