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Wfts <br />1 ATE <br />cj�. <br />APPLICATION! FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS XELECTRIC ❑ __ —� <br />259.8810 <br />❑ DEMOLITION [-I COMBINATION BUILDING ;)<MECHANICAL PLUMBING SIGN <br />TENANT MAILNESS CRY zip PHONE <br />ARCHITECT OR DESIGNER MAILADDRESSCITY ZIP PHONE <br />GENERAL C94TRACTOR MAIL ADORES <br />/lei 01 '0A, / ' <br />i3�� �j�7 <br />CITY ZIP <br />1k �iPy�,ur <br />PHONE STATE LICENSE <br />3�5 `� 95 /1�A1�AUF/ S'i oT <br />MECHANICAL CyCgk�BjTk�^ W0.ADDRESS <br />CITY ZIP <br />PHONE 3TATE LICENSE <br />/L <br />UTABYq CONTRA/CVOR MAy;1��ES6 <br />i�nx <br />CITY ZIP <br />PHONE STATE LICENSE <br />/�0 <br />37�r /3o2_LT�o 3spa <br />—CLASS OF WORK u <br />MucW rl AnmmnM 1 AITFRATION <br />REPAIR <br />I I DEMOLITION I <br />! WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WDRN <br />CrONTACT PEERSON AND PNDNE NO <br />I C, " L('N <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />.0 D 1i _ <br />PROPO4ED USE OF BUILDING r� <br />I H&EBY 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 GOVERNING 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 AUTI ORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WI RK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />LEGAL OESCRIPT OF PROPERTY IBNOWN B OR A17ACNfWR COPIEBI <br />LOT BLOCK L�_ OF S.P ZAlf40��eZ�/.3 <br />V2 <br />PRGJKTAOGRESS <br />%1j (D D %� . <br />�� <br />TMu o tE <br />cmeuePrt6ALK:[NSE No <br />PLUMBING <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 />AIC-A(HNDLG UNITS-H.P. <br />BATHTUB <br />- <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY WASH BASIN) <br />- <br />UNIT HEATERS-B.T.U. M <br />_ <br />SHOWER <br />CLOT14ES DRYERS <br />' <br />KITCHEN SINK & DISP <br />- <br />VENTILATION FAN <br />' <br />DISHWASHER <br />'- <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />URINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF OR LINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR, ETC.) <br />' <br />- <br />, <br />SUBTOTAL f,- <br />SUBTOTAL $ <br />' <br />_ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE $ <br />' <br />TOTAL FEE f <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />rS <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />BUILDING <br />PLUMBING <br />TYPE OF LONTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />OCL1P✓ICY <br />BwIP <br />Aq a fM'IwAA VN,E <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />OCCUPANCY LOAD <br />REASON FOR SPRINKLERS <br />INTAKE BY <br />F IRE SPRINKLERS REDO <br />PLANS APPROVED BY <br />HEIGHT UMITATKIN <br />CITY OF EVERETT <br />LOCAL SALES <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />S <br />RECEIPT NO <br />FEE <br />