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APPLICATIOk FOR CONSTRUCTLA PERMIT n <br />TO BE COMPLETED IN INK -PLEASE PRINT <br />pm l VP,gwe" <br />CITY OF <br />everett FH EATI TEM: <br />] <br />BUILDING DEPARTMENT <br />Bc�GI &_4+,,ZT Pt" GK a!o`�Ti <br />259-ae.0 <br />DEMOLITION COMBIIino BUILDIN MECHANICAL <br />PLUMBING SIGN <br />OWNER MAIL ADDRESS CHY ZIP PHONE / <br />qs,,, 3#;- -ter -- <br />TCTIANT MAIL ADDRESS CITY ZIP PHONE <br />q". 4 °d uo E fif"rr rl83o3 �le�o <br />- QlQ3 <br />4 z& -3v3 4A <br />A INTF.CT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />�� goo s.w. t1�5r RY1tor1 4&�ss ��- <br />SSoa <br />ENERA CONTRACTOR MAIL ADD IS CITY ZIP PHONE <br />LICENSEE <br />MECII NIGAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />LICENSE A <br />�.// .rAe to ��lSG7 .S�.�rrte 481a� 7b7.5i»sX3.7s <br />IIVEstrs�r W <br />PLUMBMOWRAC. 011 MAIL ADDRESS CITY ZIP PHONE <br />LICENSER <br />CLASMF WORK <br />/.. t.-...000eln nPMnl ITION WOODSTOVEIFRPL INSERT <br />BUILDING RELOCATION <br />NtVV AuuIIIViN .. ----- _ <br />CONTACT Pr RSON AND PHONE NO <br />T <br />CONTRACT PRICE OF WORK Y� <br />767-SMS X-3. lV <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Coi[ROS2v!E TIF4t�Tb,2 EILMMtS� <br />PROPOSED USE OF BUILDING ` <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />/� wp, _!� � u (�f14 4 r <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />/iE'hGALNDE6CRINPT11oN`OFGPROPERTYISHOWN <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />BELOW ORATTALH FOUR GOPIE51 <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />IDT BLOCK <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />— - <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 />SIGNATUREOFCONTH TOR OR AUTHuHIZEDAAGGEE/N/T DATE /` ]J <br />X _ W � • • 1 I <br />-_ <br />PROJECT ADDRE 55s �_/ <br />A I ANTSC VBUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING A <br />CHANICAL <br />FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT _ <br />WATER CLOSET (TOILET) <br />A/C —A HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN] <br />UNIT HEATERS--B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE__ <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS--RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />t+ <br />PERMIT $ <br />PERMIT $ <br />/1 <br />TOTAL FEE $ <br />TOTAL FEE $ <br />. <br />FOR L) "flUt: UbM <br />FRONT SETBACK <br />USE ZONE <br />UPALT: <br />REAR SETBACK <br />LOTAREA <br />SIDE SETBACK <br />VACANT SITE <br />PLANC^HECK NUMBER CCE <br />J7� Z <br />FEES <br />VALUATION <br />RECEIPT NO <br />FEE _ <br />BUILDING <br />TYPE OF CENTS ALLOWABLE <br />TYPE DT CONST ACTUAL <br />mc... Ncl <br />GRNP <br />NO IN MILHNGUVm <br />PLUMBING <br />MECHANICAL <br />MECHAN <br />r+ <br />��'a �� <br />VIC <br />SIZE 01:ROD <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />I <br />OCCIIrAIIGY LOAD FIRE SPRNKLERSREOD HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />INTAKE BY PLAN APPROVED NY CITY DF EVERETT <br />LOCAL SALES <br />TAX CAL <br />IS 3105 <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />