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APPLICATION FOR CONSTRUC'TiJN <br />PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />nIP [.r.gmrn <br />cnroF <br />everett <br />HEATING SYSTEM: UGAS UELECTRIC U______---- <br />1 <br />BUILDING DEPA•3TMENT <br />— <br />259-8810 <br />)(DEMOLITION 1 1 COMBINATION I I BUILDING I (MECHANICAL <br />1_1PLUMBING I SIGN <br />OW.iN ITMAILABDRESS I CITY TIP PHONE <br />e �% 6;;4f1 -��_�reiMw ika03 <br />`63o <br />(Tfe.,4 <br />TENANT MAR ADDRESS CITY IP PRIM <br />48D03 <br />ARCHITECT On drstoNtO MAIL ADDRESS CITY 71P PHONE <br />lR707y]]I'crsr <br />IF.stClw,�� �e.Tst. /IB rIAIY Ver-anaa 9e�oyllFLICENSEG �l aiADDRESS <br />ce �0,40 <br />MI'. CHANICALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />LICENSE <br />PLIIIAnR1O CONTRACIOR MAII AUmirrm— —_ _ -CITY ---- 711• PHr%r <br />IICFNSEA <br />CI ASS Of WORK 'yam, <br />! ' NEW I I ADDITION 1 1 ALTERATION 1 1 REPAIR y� r�EMOLITION I I WOODSTOVE/FRPL <br />INSERT i i BUILDING RELOCATION <br />CONTRACT PRICE Of ' YKIRK <br />CON [PERSON,AryIDPITONE NO <br />�'L-/-� L .Q.J-✓�/ 3�V 77 F'8 <br />DES,CRIBBEE WOnK A[NDDSGUAnnE,FOOTAGE <br />� INVOLVED L� <br />jj <br />PROPOSED USE OF BUILDING / <br />I HEREBY CERTIFY THA. 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 />AUTHOHITY 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 COMPL'/ WITH THE STATE <br />CONTR CTORS LAW 18,27 RCW AIJD 29e.200 WAC. <br />slGHnro or con macron On AUUlornzeO AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELGWGRATTTAC14 FOUR COPIE ) <br />Lot 156 DLCK,K OF Ld.Q5 LJ 0 i 1d <br />..— <br />-- — <br />—_ — <br />PnojECT nnnni s@ c1ru <br />APPLICANTS CITY BUSINESS LICENSE NO ANO BUSINESS NAME <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 />_ <br />A/C—AIHNDLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />�_ <br />UNII HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS_ <br />KITCHEN SINK S DISP <br />_ <br />VENTILATION FAN <br />1 <br />DISHWASHER <br />RANGE RANGE Ii00_IJ_ <br />LAUNDRY TRAY <br />WATER HEATER <br />; <br />_ <br />_ <br />CLOTHES WASHER <br />�— <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE E, CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />—�— <br />ROOF DRAINS—RAINLEADERS <br />�— <br />_ <br />_ <br />EXHAUST FAN <br />SINK (SERVICE —BAH• ETC.) <br />; <br />1 <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />— <br />T— <br />PERMIT $ <br />—�— <br />_ <br />TOTAL FEE $ <br />' <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />BEAR SETBACK <br />SIDE SE TRACK <br />PLAN CHECK NUMBER <br />FEE <br />NFC.F IrT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />—�T <br />BUILDING <br />-- <br />i <br />---- i <br />_ <br />TY)E dCBNrq MLGWABIE <br />TYPE 0 CDNSTACNAI <br />ICRRANGF <br />IRomitwImUl <br />GRd1" <br />PLUMBIN3 <br />SIZE OF BLBO <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD FIRE SPRNKLERS REG D HEIGHT LIMITATION <br />OTHER <br />' <br />REASON FOR SPRINKLERS <br />- <br />1 <br />STATE BUILDING SURCHARGE <br />!� i <br />INTAKESY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />y S7j <br />TAX CODE IS 3105 <br />