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APPLICATIC I FOR CONSTRUCT <br />' 3N <br />PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS <br />❑ ELECTRIC <br />U <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION I I COMBINATION ➢C BUILDING <br />MECHANICAL <br />1 ;PLUMBING SIGN <br />rOWNER MAIL ADDRESS CITY <br />ar� Jo�►rwor+ g50Z (ci{H.�yp,�,•� F- et <br />ZIP <br />gkce, <br />PHONE <br />ss-l-*w <br />T RANT <br />IL ADDRESS CITY <br />ZIP <br />PHONE <br />AFICHLTECTOEDESI <br />NEfl I MAIL ADORESS -IrN CITY <br />ZIP <br />PHONE <br />l �O <br />Yam/ <br />G NE TRACTOR MAIL ADDRESS CITY <br />. l'11� lGbPl. S E 1�iPnt <br />q <br />ZIP <br />"P <br />PHONE <br />3 rZ14 <br />STATE LICENSE A <br />44FFNG1104" <br />MECHANICAL C RACTOR MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTPACTOR MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE# <br />I I I I AnnlnnM IV AI TPMATInN i I RPPAIR I I DEMOLITION I I WOODSTOVEIFRPL INSERT i I BUILDING RELOCATION <br />CONTAr,T PERSON AND PHON <br />CONTRACT PRICE OF WORK <br />ESCRKIE KAND SQUARE FOOTAGE OLVED <br />r: <br />PRGPD D E B DING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />a <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />_OFF <br />Cl1 aM <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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x �{ <br />L <br />SO?� i1�•.4l4iTGQ <br />PROJECT ADDRE <br />SIONNiunE <br />I TE <br />— <br />1rer'e <br />aQ :D8 <br />CITY BUSINESS UCENSE NO - <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C -A HNDLG UNITS-H.P. <br />T <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />-T <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <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 />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />- <br />I <br />I <br />I <br />' <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />' <br />TOTAL FEE $ <br />' <br />Sj(a' <br />Fnr OFFICE USE ONLY: <br />FR': uE7 DK <br />REAR SETBA K <br />`RErv' <br />SIDE SETBAC , <br />PLAN CHECK NUMBER <br />FEE ,90 <br />RECEIPT NO. <br />O/ <br />�//LS <br />LOT A <br />N <br />VACANT SI E A <br />N f. <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />2Coeo <br />, <br />— <br />TYPE OF CONTS. LLOW�ABLAE ' <br />F v <br />Av'1v <br />TYPE OF 0 St ACTUAL <br />`75 <br />N <br />MCUPANCY <br />No almt Ix IWnS <br />,E OF BLDL1. •' <br />SIZ <br />• <br />NO. GF1 <br />"V�►V <br />BASEFAENT <br />U — <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />i <br />OCC ANCY LOAD <br />REASON FOR� S.{P�RI.N.yKLER�S�yr <br />Lh.VIAlw-p' <br />FIRE SPRNN ERS RED <br />'.i0� - f1�iTJM <br />wow ft zvjF" <br />HEIGHT LIMIT I f� <br />T • <br />SPRINKLER <br />' <br />Fogo J � <br />STATE BUILDING SURCHARGE <br />iJ <br />INTAKE BY <br />PLANS APPROVED By <br />��2 JM <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />