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APPLICATILA FOR CONSTRUCI.ON PERMIT �Vefett <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />he EveTg een <br />CITY OF <br />everett HEATING SYSTEM: J GAS J ELECTRIC J — <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION �I BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY 71P PHONE p <br />z 11) 1 RV <br />/rejm i 'XXJZ� JI�tiT1<P <br />TENANT MAIL ADDRESS C�"�"" � ZIPP PHONE <br />f.�/_7 TSi <br />ARCHITECTOR DESIGNER MAIL AO RESS CITY 21P PHONE <br />. 3uz� ��Gal�yr �,e'i-rr' �zd ZsTj -Srs�1� <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE It <br />!' <br />MELHANIULGONTRALTOR MAIL ADDRESS <br />CITY ZIP PHONE ULENSEI <br />PIUMBINy CONTRACTOR MAIL ADDRESS CITY zip rrnme <br />//A <br />CIA S OF WORK <br />N REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />NEW Y ADDITION ALTERATIO <br />CONTACT PERSON AND PHONE NO <br />n n <br />CONTRAST PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />/.�� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGALD COPIES) OF PROPERTY ISHovm BELOW ATTACH FOUR coPlE <br />of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK _ <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 />..7lLsi- w <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 />SIGNATURE CONTRACTOR AUTHORIZED AT DATE <br />X�aylg <br />/ <br />PROJECT ADDRESS 3O <br />APPLICANTS GITV BUSIN[55 LICENSE NO AND BUBINESS NAME <br />, p <br />� OZ� <br />PLUMBING,40� <br />FEE <br />MECHAIMAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H. P. <br />FORCED AIR SYSTEMS-B,T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />E%HAUST FAN <br />SINK (SERVICE -BAR, ET0.) <br />�- <br />SUR TOTAL S <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR UFFILa U= <br />FRONT SETBACK <br />Unu: <br />REARS CK. <br />SIDE S[TBA N <br />�€.REC <br />IPT NO <br />USE ZONE <br />�•GTYPE <br />LOT AREA <br />VACANT SITE <br />FEEESVALUATION <br />FEE <br />tPLANECK;UMBER <br />OE CENTS ALLONABLE <br />TYPE Wr;DNSTACTUAL <br />_ <br />occu°xxcv <br />.ING <br />L� <br />NO U DYhG114 UNITSV <br />p <br />MECHANICAL <br />I <br />SIZE OF BLDG. <br />sr <br />NO. OF STORIES <br />BASEMENT <br />No <br />PLAN CHECK <br />D J� <br />OCCUPANCY LOAD FIRE BPRNKLERS RED HEIGHT (IMITATION <br />NA <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />PUNS APP <br />/ <br />CITY OF EVERETT <br />LOCAL SALES <br />IS31 <br />TAX CODE IS 3105 <br />TOTAL <br />/o ,� <br />