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xfx3C3 <br />tr. H <br />o <br />>x9Hx En <br />EA <br />HZ� <br />EC C] <br />Hx <br />ox� <br />Al f Hq <br />yOzO <br />0 I t <br />Q�8 <br />HV �] <br />q '3 <br />H <br />H H <br />C]CGG7 CoEn <br />LLl <br />HOCo <br />APPLICATIC 1 FOR CONSTRUCT. aN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC U <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN ' <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />— Z, %o,F.. 'u, u g920' 34) 0413. <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />RIIXEE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PNONE <br />STATE LICENSEE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />STATE LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />CLASS OF WORK <br />NEW ADDITION ALTERATION X REPAIR DEMOLITION WOODBTOVE/FRP`L INSERT BUILDING RELOCATION <br />Y.. ^ fAM� PERSON AND PHONE NO.I.. <br />CONTRACT PRICE OF WORK n :?. J <br />DESCRIBE WORA1AND SQUARE FOOTAGE INVOLVED �.y <br />Ai (GE!' olA S%A�Cf WICM AQMJ 20 pa SY <br />PROPOSED USE 1, BUILDING <br />W e� I I nq <br />— . — - ' <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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESI ]ME 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 CO%IPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200,W/AC. <br />%tea yv+c0`I&-zw <br />SYINATVPE i[ <br />fiIT BUSMASLICENA[NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />LEGAL DESCRIPT OF PROPERTY IyNO'WfN BELOW OR ATTACH FWRCOPIES) <br />LOT BLOCK OF <br />OF (v�BAA,�Lh JTe <br />ADOIIESS 'Lp <br />PRCUECT 4 S <br />If' g2L.A -5-h V Cv�LEP t, g42oS <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />I <br />' <br />AC—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />UNIT HEATERS—B.TU. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />RANGE HOOD <br />' <br />WATER HEATER <br />' <br />_ <br />WOOD STOVE <br />METAL FIREPLACE 6 CHIMNEY <br />! <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />EXHAUST FAN <br />' <br />ROOF DRAINS—RAINLEADERS <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />_ <br />I <br />_ <br />SUBTOTAL f <br />SUBTOTAL If <br />PERMIT f <br />PERMIT f <br />FEE f <br />TOTAL FEE f <br />iTOTAL <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USE WE <br />LOTAREA <br />IVPE Of LONIS. ALLOWABLE <br />TYFFMLONSI AC' <br />SIZE OF BLDG <br />NO OF STORIES <br />T)E UMMY LOAD <br />FIRE SPRINKLER) <br />VACANT SITE <br />PCeif <br />-- <br />iC0 <br />BUILDING <br />- <br />IAl <br />IXLWAKr <br />Xc dOMit'AS IAIS <br />' <br />GAdp <br />PLUMBING <br />MECHANICAL <br />_ <br />, <br />I <br />' <br />BASEMENT <br />I <br />ADDITIONAL PLAN CHECK <br />REGID HEIGHT LIMITATION <br />SPRINKLER <br />; <br />Y ! <br />STATE BUILDING SURCHARGE <br />er <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />