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4. <br />tho EYerpresR <br />9 CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•BS10 <br />d <br />APPLIC . R ON FOR CONSTR 2-TION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />ByyyoL Larra her <br />21SOZ Hwy <br />q(4 Epinatjbc <br />CibyZu <br />�l4 <br />IEWNT� �-KMAIL ADDRESS <br />L <br />e UCK- PAPTs,Ltic, <br />CITY <br />saH� <br />ZIP <br />PHONE <br />ARCHITECT OR DE SIGN ER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />\.\ 1� <br />OW N(F <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE IF <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CTY <br />ZIP <br />PHONE LICENSE• <br />rl NFw bd ARDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEME NT OR INTERIOR REMODELONLY <br />CONTRACT PRICE Or WODK Jt3/ LNb• oo <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />/AYL-)Drr%Lq.11S Iy l""<IS II�GY �itD(a. <br />�1y11� 1Li <br />-- <br />PROPOBED USE Of BUILDING <br />U HC34Y <br />_ <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 />t <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NO. <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 PERrORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPL)' WITH THE STATE CONTRACTORS L/N/I827 RCW AND <br />298.200 WAC <br />296SlaRATURF Or CONTMP.IOII^OR AU11IOnIZFO AOENi DAZE <br />AP �� ` <br />APPLICANTS Y BU91 R CONI A. BU91NE8fNl <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK Of <br />— <br />-- <br />PROJECT ADDRE99 <br />Z?3(5 Cb.C.OL6I00U eu. (SoLp-e-m <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 />A/C — A/HNOLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASINI <br />_ <br />UNIT HEATERS —BT.U. M <br />_ <br />CLOTHES DRYERS <br />_ <br />_SHOWER _ _ <br />SINK & DISP. <br />VENTILATION FAN <br />_KITCHEN <br />DISHWASHER <br />RANGE HOOD <br />'LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEATPUMP <br />_ <br />BACKFLOW PREVENTERS <br />GASPIPING <br />_ <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />_ _ <br />SINK(SERVICE — BAR. ETC) <br />SUBTOTAL <br />S <br />SUBTOTAL i <br />_ <br />PERMIT <br />S <br />PERMIT B 1 <br />_ <br />_ <br />TOTAL FEE <br />t <br />TOTAL FEE i <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE BET;aCK <br />►LAN CN CK NUMBER <br />FEE <br />RECEIPT NO , f <br />USEZONE <br />AY/I 1 <br />/, / <br />LOTAREA <br />VACANT BII� <br />D YES ) HO <br />FEES <br />VALUATION <br />FEE <br />'- <br />BUILDING <br />TYPE Of CON9i .� <br />ALLOWABLF/ACTUAL <br />OCCUPANCYOROUP <br />N . <br />NO OF OWELIING UNITS <br />PLUMBING <br />- <br />SIZE OFFILMNO <br />�o p SF <br />F STORIES <br />OP; <br />; <br />BBMT. <br />o Y <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE 6PnINKI_ns nr0umrD Dvea No <br />NEIONTL IIATION <br />/ 9loR <br />STATE BUILDINO SURCHARGE <br />/.PPLICATION ACC BY PLANS.°PR. BY <br />n <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />� <br />