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APPLICATION FOR CONSTRUCTI,JN PERMIT f -1 <br />TO BE COMPLETED IN INK —PLEASE PRINT ,. <br />4 <br />IAP ERFrprwn <br />CITY OF '' J <br />everett ' = <br />HEATING SYSTEM: U GAS TR C U <br />BUILDING DEPARTMENT - <br />259.8810 <br />I 1 DEMOLITION I I COMBINATION <br />OWNER MAIL ADDRESS <br />BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br />PHONE <br />n.,iVDY <br />Dl17ES <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHRECTOR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL <br />MAIL ADDRESS <br />LICENSE F <br />MECHANICAL CONTRACTOR <br />MAIL AGGRESS CITY <br />ZIP PHONE <br />LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />21P PHONE <br />LICENSE A <br />CLASS OF WORK <br />,V........ .. <br />T-I .aeoA,rinu I I DGDAID I I nrunIITION <br />I I WOODSTOVEIFRPL INSERT <br />I.1 BUILDING RELOCATION <br />,_' ,•�•• ••V✓•..v.• .. <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK bCJ <br />� <br />DESCRIBE WORK AND SOUARE FOOTAGE VVEO <br />Q <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />C Q <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />FOUR COPffBG <br />LEGAL DESCRIPTION OF PROPERTY ISNOWN BELOW OR ATTACH <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 />` fb <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />v <br />A <br />PROirc ApORI SS <br />I / <br />\ <br />COYB INE9 NSE 10 AND BUSINESS NAME <br />PLUMBING <br />MECHANIC _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE _ <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS—H.P. <br />' <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />1 <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />' <br />VENTILATION FAN <br />i <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />' <br />BACKFLOW PR ENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRA RAINLEADERS <br />I EXHAUST FAN <br />' <br />_ <br />SINK (S@ VICE —BAR, ETC.) <br />� <br />I <br />I <br />! <br />I <br />' <br />— <br />I <br />' <br />SUB TOTAL $ <br />1 <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />' <br />TOTAL FEE $ <br />TOTAL FEE E <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK I REAR SETS <br />_ F <br />ALLDWABI I <br />OAyp, os_ <br />slzE OF oLee�A,A C <br />I <br />OCCUPANCY LOAD FIRE SPRNKL ERB RED <br />4 AMO <br />REASON FOR SPRINKLERS <br />INTAKE BY PLANS APPROVED BY <br />czx,V <br />SIDE SETBACK Pt AN CHECK NUMBER FEE RECEIPT <br />oB 9e /a r/ 6 0 /Ye `/e �_; <br />M� <br />BUILDING <br />PLUMBING <br />0[CIMNLr <br />�li"41P <br />IIIaaAllIAO MB't <br />BASEMENT <br />ILL b <br />HEIGHT �LIMITATION <br />GC7A <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3165 <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />Iwo <br />