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i <br />APPLICATION FOR CONSTRUCTMN PERMIT <br />IT EvP.pwn TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />r HEATING SYSTEM: U GAS ❑ ELECTRIC U _ j <br />DEMOLITION <br />COMBINATION X BUILDING <br />'. MECHANICAL <br />PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS CITY <br />Box 3107 fns•d�7G <br />ZIP PHONE <br />SC4rrLK WA. 991114 <br />3 ft-S878 <br />-fly BonAsdn <br />Grt , f'.d• <br />TZIP <br />TENANT <br />MAILA RESS <br />CITY <br />PHONE <br />SA•m6 ha <br />mwNcz <br />ARCHITECT OR DESIGNER MAILADDRESS <br />�-tR6ENE /S 5.rjfLFDT/ <br />CITY ZIP PHONE <br />wa RfNraN, wn. 9Qerr <br />Y. <br />23s -/G F7 <br />LoGKWOoC <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />43io_—fu8 NE�RNNoA/D <br />ZIP PHONE <br />WA. 9603 <br />-.- <br />LICENSE # <br />LenSSCL/18 Ng <br />LCA•SG [RLArtlf6rc <br />LCAVFi, <br />PHONE <br />LICENSEE <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PLUMBINGCONTRAJ AR <br />MAC ADDRESS <br />CITY <br />lip PHONE <br />LICENSE# <br />CLASS OF WORK <br />El NEW ADDITION L: ALTERATION REPAIR i I DEMOLITION ! 1 WOODSTOVE/FRPL INSERT G BUILDING RELOCATION <br />y CONTACT PERSON AND PHONE NO. <br />EK.. IA_n d,.,,c V.AeAr.1 2f'b-3r6"S <br />CONTRACT PRICE OF WORK ' "� — <br />-- -- — - <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />•j'> OV407 FMPrt+�GMCNfS <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />WIN* 5P4 q AYiSBM N. <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR rAPIE51 <br />LOT BLOCK OF <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 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 OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X <br />� / <br />PROJECT ADDRESS rlo �O.I <br />',jpdj <br />�6 BUSINE LICENSE NO AND BUSINESS NAME <br />W GaSr No R.0 Y <br />77 <br />PLUMBING <br />MICA <br />MECHANICAL <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />i <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />I <br />' <br />I <br />' <br />' <br />I <br />I <br />I <br />SUB TOTAL E <br />i <br />SUB TOTAL i <br />PERMIT E <br />I <br />PERMIT III <br />TOTAL FEE 9 <br />' <br />TOTAL FEE E <br />run vrrvlQ vJG <br />REAR TBAGN <br />SIDE SET <br />KAN CHECK NUMBER FEE <br />RECEIPT NO <br />FRONTSET CK <br />4 <br />A <br />4T, a7 <br />USE <br />LOT AREA <br />v ANr tE <br />FEES VALUATION <br />FEE <br />BUILDING <br />1.310.0� <br />�� <br />TYPE OF CONIC ALUMMILE <br />TYPE OF CBBST ACTUAL <br />IKLVAYtr NoaowU wuxnr <br />PLUMBIN13 <br />I <br />T <br />6ME OF BLDO. <br />NO OFSTORIES <br />BASEMENT <br />D <br />N <br />MECHANICAL <br />.PLAN CHECK <br />�4 <br />Ilo� So' 59FT <br />r <br />OCCUPANCVLOAO <br />FIRE� PE09 <br />HEIGHT LICMIITAT7N <br />OTHER <br />A-ti (jet yaL, 33A <br />,61P-RNKlER4 <br />I �S <br />D a I <br />REASON FOR SPRINKLERS <br />Jo c <br />STATE BUILDING SURCHARGE <br />HOW BY PLA A ROVED Br CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />— J TAX CODE IS 3105 <br />TOTAL <br />�( f <br />J <br />