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APPLICATIO..:'OR CONSTRUCT. 1 PERMIT Vefe1t <br />1,e EYP,U,PPA TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett <br />HEATING SYSTEM: I, GAS <br />U ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810t <br />DEMOLITIO14 COMBINATION BUILDING <br />)M CAL <br />PLUMBING SIGN <br />OWNER MAIL <br />�... MAIL ADDRESS �)� � /.CITY ��/� {�� <br />M1c`/L.Y+V{+1 L pU CJC)^ �7{�' �T—lAN�A ULi <br />ZIP Q o PHONES l �-�//�/ <br />/ O/ A/i[� <br />` `KZ <br />-tic <br />TENANT _�-T-MAIL OU.-.J1L.. <br />ZIP PRONG <br />ARCHITECT OR DESICNER MAIL ADDREE5 CITY <br />neft� . ^►wu�n &70-1 f3nse*+ tofu LJ &atifeF <br />ZIP PHONE <br />gal LA -840e6 <br />GENERAL CONTRAC'OR MAIL ADDRESS CITY <br />ZIP PHONE <br />9fii�A '71e2 <br />LICENSEENEC <br />MGK-in�S-l-(��-S C' 2�1 � <br />331I <br />Ki 3nA <br />MECHANIC?L CONP1ACi0C MAIL ADDRESS CITY <br />_mc v ir�,Co i b by a4 7 S(MKJ <br />ZIP PHONE <br />%04- Z7 33) <br />LICENSEE <br />I MCC d#J31Z_o, <br />PLUMLI T. EbTNTRACTOR MAIL ADDRESS .AwCITY <br />Mc C1 , nsig C� PC IU, Zel-%7 �eaOty, <br />ZIP PHONE <br />�i8I Z4 <br />LICENSEE <br />k44y72�y <br />CLASS OF WORT i <br />NEW ADDITION - - ALTERATION REPAIR DEMOLITION <br />WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRA.;T PRICE OF WORK ,' J % 333 :733. 33 <br />CONTACT PERSON AND PHONE NO <br />Cl-t1..-'l �l iTh1115Ps <br />DE'iCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />-co✓,ruSi0-n Sli1iIna-IVY-f 2 33 1I , -eK-t I <br />56 <br />PPOPOSEO USE OF BUILDING ^ :ERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOU OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />COMPLETED WITH <br />LOT BLOCK OF T� J J . 3ANT NG OF APERMIT DOES SPECIFIED HEREIN DOES NOT PRESUME TO GIVE <br />TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />ICE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />)N IS MADE AND I COMPLY WITH THE STATE <br />CORMAOTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE 12.--17-9I <br />-1 nn T <br />Mw.�$ <br />/—r"aEE/`f <br />1Tj.--1Lr- <br />�Ld— LA�- IaE <br />PROJECT ADDRESS <br />zlG -. } 'a E/ 3 <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINES ME <br />PLUMBING <br />MECHANICAL <br />_ <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—AIHNDLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—_ B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DICP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />WOOD STOVE <br />_ <br />URINAL <br />MIJAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />_ <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />_ROOF <br />SINK (SERVICE —BAR, ETC.1 <br />K S <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />F PONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />3s/3� <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />XCUPANCY <br />NO GI PAUI.NGUNP75 <br />LROiP <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />UECUANK)AL f • L..-.+-EC,(� <br />S <br />D <br />AJ/jBL PLAN CHECK <br />p <br />8 '2U <br />OCCUPANCY LOAD FIRE SPRNNLERS REDO HEIGHT LIMITATION <br />OTHER <br />--T- <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS fPPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />8� d <br />I <br />