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APPLICATIOrd FOR CONSTRU jT <br />ON, EIBBIRR , _ �U j everett <br />CITY OF JUN - 4 )G9� <br />everett _ <br />BUILDING DEPARTMENT `..... OF EVERETT, <br />259.8810 TO BE COMPLETED IN INK —PLEASE PRI`(M <br />Subila Works Dept. <br />CI DEMOLITION COMBINATION - BUILDING MECHANIL PLUMBING SIGN <br />OWNER MAILADDPESS LNY ZIP PHONE <br />g� T� ITT a. I. Iq Mum- 64 SETTg 82os <br />LENINT MAIL ADDRESS CITY ZIP PHONE <br />MAE <br />ZIP <br />GENERAL CONTRACTOR MAL ADDRESS CRY ZIP PHONE LICENSE <br />AMFr21Cgy &C1161 PC)T-ZOM 131 FA-COMh 9R`{(,(o �,Tb)G27.7M, 50-00I-21 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR <br />ZIP PHONE <br />C1A550F WgIN <br />f NEW 1 ADDITION !.� ALTERATIONiRdDEMOLITION --IWOODSTOVE/FRPL INSERT G BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTEPA`RPLMODEL ON" <br />CONTRACT PRICE OF WORK: IJC7D <br />/ <br />COMA/Gi PEPm,}N AND PHONE NO —1 <br />C��S/I ��T (og-7- IL L16 <br />DESCRIBE WORK AND SWAR-.FOCI INVOLVED <br />IM T L <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 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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WCRK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAD. <br />SbNATUREiPAC OO�flJ/AJJU�INORIIED AGENT GATE .A <br />X " "" lit -if SN DO I <br />LEGAL DESCRIPTION OF PROPERTY ISIOWN SELCTW OR ATTACH TWA COP'ESI <br />LOT BLOCK OF <br />rrul }. qq — <br />—Q� — QOQ <br />—4— <br />In <br />IY <br />PROJECT ADDRESS <br />q f) <br />I�iii1�� )L <br />k``'"'11 ,, JJ CC <br />APPL <br />CITY BUSINE -I AN I /JAE <br />/�/ <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 />NC—NHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOWPREVENTFRS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT <br />$I <br />PERMIT $ <br />TOTALFEE $ <br />1 <br />TOTALFEE $ <br />FRONT SETBACK <br />< <br />BEAR SETBACK <br />.A . — <br />SIDE SETBACK <br />PLANDHEC NU BE <br />FEE <br />RECEIPT NO <br />USE ZONE p <br />�--`� <br />IOTAREA <br />VALANTSITE <br />.i YES c. NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />QO <br />TYPE O CONSI. ALLDAMLE <br />TYPE O BEAST Ulm <br />omINIIY <br />Afl DAturvc Miltt <br />WE OF BLDO. <br />NO OF STORIES <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />OCCUPANCY LOAD FIRE SPRINKLERS RECTO <br />L YES , i NO <br />REASON FOR SPRINKLERS <br />HEIGNTLBAITATIW <br />L"J <br />STATE BUILDING SURCHARGE <br />Q <br />STATE ENERGY SURCHARGE <br />APPLICATION ACE by <br />PLANS APPPOVED BY <br />2 j _J14 <br />CITY OF EVEBETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICWORKS <br />TOTAL <br />1 <br />1 43- ) <br />