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I <br />APPLICATIO—i FOR CONSTRUCT. Al PERMIT everett <br />Ow EYRrp~ TO BE COMPLETED IN INK -PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: O GAS J ELECTRIC - 'g6Et jn -----� <br />BUILDING DEPARTMENT <br />259.8810 <br />:: DEMOLITION _ COMBINATION BUILDING MECHANICAL PLUML ING SIGN <br />OWNER MAIL ADDRESS ZIP PHONE <br />i�><c (3c/Ns r_A. Po. 6or 370; nl� Co"� 76 S�aac.E c�A, 9�f�H 3y2-� �7Y <br />TENANT 0.ADO1E88 CITY ZIP PHONE <br />SMT+E A-5 owu�,L <br />ARCHITECT OR DESIGNER WIL ADDRESS CITY ZIP PHONE <br />LooewooD C2�Lrn/�✓ , /S SocAr%F 62A�y way, A.SA7D✓,t�a•98Ats- 23t -/6y7 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY/' ZIP ' NONE IICF,NBES <br />tS-A5t£ C2U•lr,/*` R c.Grw/sr 30 /ypP—:N6 ecomomb,Pvl?•`*C73 Ler4sECLr18N8 <br />MECHANICAL CONTRACTOR W0. ADDRESS CITY ZIP PHONE LICENSES <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />SS OF WORK <br />NEW !_1 ADDITION I7 ALTERATION f I REPAIR DEMOLITION I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK 1 y/' O A OOO <br />CO TW PERSON AND PHONE NO, <br />C� M7b N /i,L I) T As ra-m acoesIO' <br />DESCRIBE WORK AND SQUARE FOOTAJEI VEO <br />2 �y 7 <br />PROPOSED USE O BUILDING qo-ocl <br />LV I AF GP SPA-& 7}-SStL'7v! (, <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 WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 298.2DO WAC. <br />SIGNATURE OFCONTRACTOR OR AUTHORIZED AGEENTT�^/D DATE <br />APIY(IGNHiS CITY BU5111F �ICENSEBUSINESS NAME <br />NO AND <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT BLOCK OF <br />PROJECT ADDRESS <br />00 (A/•i-Y18/NO ILA. <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 />A/C—A/HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.LU. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK & DISP <br />i <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE& CHIweY <br />—�— <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />BACKFLOW PREYENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAIN AINLEADERS <br />I <br />EXHAUST F <br />I <br />SINK (SEX E—BAR, ETC.) <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL S <br />' <br />PERMIT E <br />_ <br />PERMIT E <br />N <br />TOTAt. FEE $ <br />_ _ <br />TOTALFEE 3 <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECKNUMBEA <br />9/ J7Y <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TvN OrJU11I8.AUDW F <br />TYR NX CDNST <br />oa,P,AnI <br />AO Ix ,,.I,I, wum <br />PLUMBING <br />SME OF <br />)lP� &00. eq.FT. <br />NO OF STORIES <br />/ ntaa, <br />BASEMENT, O <br />'V <br />MECHANICAL <br />i <br />ADDITIONAL PLAN CHECK <br />— <br />� <br />OCWPAOr FIRE,RAWLERS REOD HEIGHTLWITATION <br />SREASON FOR SPRINKLERS <br />COOL <br />' <br />STATE BUILDING SURCHARGE <br />--T <br />7 <br />INTAKE BY <br />PLANS AP BY <br />�; <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />iy <br />J <br />■ <br />