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POW., 10 <br />APPLICATICA FOR CONSTRUCT I, )N PERMIT <br />Ine Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS U ELECTRIC ❑ <br />everett <br />e <br />DEMOLITION COMBINATION BUILDING xMECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CUY ZIP PHONE <br />B4I N4 6101/ ARAY ASSdM&y 25 EVEJtFs1T. ?2446&) _ <br />TENANT MAIL aDDRESS � _\ CITY 21P PHONE <br />REaOi ZoA✓Es Z t q /FP l2 `L� <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHGNE <br />GENERAL CONTMCTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSEE <br />AUS7)N COMPANY <br />/0/f-47A A✓E�bVEA�{T�4/A. <br />9l2or <br />ZiL•6Goo <br />223-OI-AU•ST-IG73mj <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />LICENSEE <br />c0seo f/RE M&7FmW <br />/09/0-//77w <br />X A/E AftAM0644 <br />918on 827-W.+ <br />wS[oFPIroNM <br />PLUMBING CONTRACTOR <br />MAIL ADORESS <br />CITY ZIP <br />PHONE <br />LICENSEE <br />CL&S S OF WORK <br />NEW I ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT L; BUILDING RELOCATION <br />/R46 <br />CONTRACT PRICE OF WORK A <br />CONTACT PERSON 1 0 PHONE NO <br />4z. S:ilm 927-46 5+ <br />DESCRIBE WORK AND SOUARE FOG rAGE 14ltXVEO <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC T. 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 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATES/�/ Z <br />Ae 9 <br />X <br />COUP fAPE A tmAvAON I0 02♦ 14 ( ¢ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELL N OR ATTACH FOUR COPIES, <br />LOT__ BLOCK OF <br />— <br />PROJECT ADDRESS <br />PPLICAIIi$f,ITY Da S'IC^;3 LIDa 1. 1:0 \NVUU]I.VE iSN.U1C <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTF" .—B TU. M E.A. <br />LAVATORY ( WASH BASIN) <br />UNIT HEATERS—S. r.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK d DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />T <br />WOOD STOVE <br />URINAL <br />IMETAL <br />FIREPLACE 6 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT ' <br />FLOOR DRAIN <br />HEAT PUMP <br />T <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />_ <br />ROOF DRAINS—RAINLEADERS <br />_ <br />9XVAUSTFAN <br />SINK (SERVICE —BAR. ETC,) <br />S / 6 t <br />z19 So <br />SUB TOTAL $ <br />_ SUB TOTAL 3 <br />PERMIT_ $ <br />_ <br />_ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE , <br />RECEIPT NO <br />Z. <br />3 -Q? <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />T <br />_ <br />TYPE Of CONTS ALLOWABLE <br />TYPE Of CONS? ACTUAL <br />Iu wucr <br />eO 1.NAlu4uuvn <br />--------------- <br />------ <br />Lxwv <br />PLUMBING <br />SIZE OF FILM <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REDD HEIGHT LIMITATION <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PUN <br />AP/P���OVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />/ <br />LOCAL SALES <br />/�L <br />TAX CODES 3105 <br />TOTAL <br />