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APPLICATIC I FOR CONSTRUCT )N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINTrtTr <br />BUILDING DEPARTMENT l HEATING SYSTEM: GAS Ll ELECTRIC U <br />259-8810 - - <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />i <br />Thtt,*L <br />yf, 'r sE. <br />guere ff <br />prt2ioz <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSEE <br />-aoz <br />I MECCONTRACTOR� MAIL ADL�C/I{�T/Y/�—�a � Zlfy� PN/ON(/EL � 7STATE <br />�LICENSE <br />�70�q��(�)/� <br />PLUMBING CONTTIAC/C/-T[OR IF MAIL ADDRESS CITY t (_xJzZZIIIPP PN E� STATE LICEIISE0 <br />CLASS OF WORK <br />NEW ADDITION xALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PER N AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVFRNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 AUTHORIZFD 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 />ull,e $6"_ <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />— <br />F1140A E. I AI IURE SS <br />913— d SKSC fiet� <br />AIUII [ <br />CITY HIMINFss Ilcual 1. <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 />A/C—A/HNDLG UNITS—H.P._ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAV <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />; <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />T <br />I <br />I <br />— <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />,J I <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />Lll <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />- <br />PLUMBING <br />MECHANICAL <br />- --' <br />i <br />i <br />' <br />TYPE OE CONTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />ncNMACY <br />cAwv <br />MOFPNEIIIABIMrt! <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />1 <br />STATE BUILDING SURCHARGE <br />- <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PURL IC WORKS <br />TOTAL <br />