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the Eve rV,PPn <br />CITY of <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLi.;ATION FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />�W I'� � Pvl•mH <br />OWNER MMLAOURESS LIT♦ to I'nOHk <br />l N Q 'f C,h i�l F.^ �it %. 1-.-.c. %;IIGk[f.C/./i(r'I ,, L_',tV f✓j �:.7G rl._ r � 7_77<�d <br />TENANT MMLAODRElS Gnx -t ZiP RIONI _- <br />ARe"rM7 OR DESIGNER <br />MEALADDRESS <br />CITY <br />ZIP <br />P"UNE----- - - -- <br />q <br />7! ='.A <br />1nCTJG1 <br />-3S ��C%5Y� <br />.54-/Q✓.V <br />OENEML TRACTOR <br />MMLADpRE85 <br />CITY <br />ZIP <br />PHONE LICENSE • <br />,a <br />a.SwJc�/ <br />2s_"3.7Xn bCo,N„Iecfi3ML <br />MECNANwAL CON/RACIOR <br />MAR ADDRESS <br />Gry <br />Z <br />PHONE LICENSE <br />PLUMBMOCONTRACTOR WAIL ADORES! GTV ZIP PHONE LICCII <br />LI,Is Sw 7H 1172i S'7 L"AE/f rJ! 4AAysF'//,r 11/4. 9`c 17n L59-/5 17 .IS4NcR411-4IXF <br />CLASS OF WORK <br />r.-i'<7 ... n ... F'I r1 RERAID rI DEMOLITION ❑ WOODSTOVEJFRPL INSERT Cl BUILDING RELOCATION <br />TfHCW VE NT OR rvn v �•.....^..�. <br />TENANIIMPROVEMENtORIN1ERIDRREMODEIONI: <br />CONTRACT PRICE OFWORK (;: ZII�A <br />- <br />DIrI `JOA EW/k <br />GONIAGI PERSON AND PHONE NO <br />E�C/�NNC�y 7;e e)e) <br />DESCRIGE WORK AND SOUARE FOOTAGE INVOLVED <br />'Jr""r✓fi..,e.ro N,;�/�.// ,sue =i. �� <br />%I�+(l•.a �. -J <br />f <br />PRDPoeEo usE DF emkolND <br />/, S IY76,dcd <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />298.200 WAC <br />BwruRE OF comoTLTOR ORAUTHORUEO AGENT DATE '1' <br />f <br />APINICAN190TY BUSMEBS UCf TISE ND ANa lUSINE83 NAME <br />LEGAL DESLRIPTgN OF PROPERTYISnpWN GCIOW OR ArtACN FOUR OORE9 <br />�I�It- ',t 7 <br />LOT. Bloch pF - <br />_ <br />- - <br />PROJECT ADORF54 <br />70.do <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />pPJ <br />(� <br />•O <br />(,C <br />lI <br />_ _ <br />_ <br />�. <br />'f _ <br />A/C - A/HNDLG UNITS - HP <br />- <br />I�y <br />FORCED AIR SYSTEMS-BT.U. MEA <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -BTU. M <br />-1 <br />SHOWER <br />--_ <br />CLOTHES DRYERS _ <br />VENTILATION FAN <br />RANGE HOODLAUNDRY <br />WATER HEATER - <br />WOOD STOVE <br />TALTAL FIREPLACE A CHIM_NEr <br />FIREPLACEINSERT <br />HEAT PUMP_-_______ <br />GAS PIPING <br />I04AUST FAN <br />II0,,; h01N3 UFLA�U_�QOr..I'T <br />SUBTOTAL -5 <br />PERMIT 4 <br />-- <br />W <br />/ <br />KITCHEN SINKS DISP. <br />_,Lj <br />__ <br />/ <br />DISHWASHER <br />TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />13ACKFLOW PAEVENTERS <br />ROOFDRAINS- RAINLEADERS <br />SINK (SERVICE -BAR ETC(_—..n__ <br />-- <br />'f <br />SUBTOTAL <br />PERMIT S <br />TOTAL FEE <br />f <br />TOTAL FEE f <br />iRON15CTBAGK <br />2/6 I <br />REARSETBACK <br />z� I <br />SIDE SETBACK <br />s <br />PLAN CH[ NUMGEG <br />I[E <br />360,lel <br />RECEIPT too. <br />14 a <br />USE ZONE <br />LDUREA <br />VACANT enE <br />, YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />-��I_ <br />_ <br />TYPE OF CONEY <br />ALLOWAM -TUAL <br />ki <br />OCtUNNCYGROUP <br />3 <br />NO MDWELLING UN118 <br />I <br />SIZE OF BLDO NO OF STORIES BSMt <br />1G11 Sf t ❑Y <br />a 2 x" <br />TIRE SPRINKLERS PCOUIPEO )YES NO <br />acc LOAD <br />HEIGHT II HAIIOM <br />MECHANICAL <br />___ <br />__ <br />()n <br />V�� <br />3 3•01 —3 D.Fp <br />OTHER CI1A[ <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC er PLANSAPPNBY <br />WON 31"fL <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />T <br />h <br />I TOTAL <br />