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e 0 lawk <br />APPLICATIO. FOR CONSTRUC?. ' N PERMIT evt /eIL <br />The Emig,"R TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />Everett BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC U <br />259.8810 <br />DEMOLITION COMBINATION <br />OWNER <br />SOEIN H <br />TENANT <br />ARCHITECT ON DESIGNER <br />GENERAL CONTRACIOR <br />AUS71N col <br />MECHANICAL CONTRACTOR <br />MAIL ADD IIESS <br />I A4Y ASS&44 <br />MAIL ADDRESS <br />MAIL ADDRESS <br />MAT'. ADDRESS <br />MAIL ADDRESS <br />BUILDING <br />CITY <br />40- <br />CITY <br />Clly <br />CITY <br />CITY <br />ZIP <br />E5 <br />71P <br />71P <br />_PLUMBING <br />zc/ 224 <br />S'.CN <br />1.� <br />ZIP PHONE LICENSE IT <br />9#2o# 266.66w 223-o1-AU-sr-1c73W <br />ZIP PHONE LICENSE <br />004 3 837.9(s4 c*SCoFPI►ot4M <br />Z.P PHONE LICENSE, <br />C SOF WORK <br />NEW I .; ADDITION 1 ! ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT _; BUILDING RELOCATION <br />t' <br />/ /rG 1. Iffl G1 Yt H$ON AND PHONE NO <br />CONTRACT PRICE OF WORK AM SPQiA/kGF,n c L/ fN P'r7i G 9.7_Ot 4L <br />LOT <br />WORK AND SOUARE''OUTAGE <br />BLOCK <br />BELOW OR ATTACII <br />Or <br />3 t <br />PROJECT ADDRESS 7.fiC.--w- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC f. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING 141S TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIEU HEPEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS JF 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 ANC I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF OR AUTHORIZED AGENT OAT[ /Ip -?z <br />APPLICANTS CITY BUSINESS LICI:NSE. NO AND BJIMESS NAME <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—AIHNOLG UNITS—H. P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. <br />_ <br />LAVATORY (WASH BASIN) _ <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />--T— <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />T <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERI,'CE—BAR. ETC.) <br />s i <br />fillo <br />SUB TOTAL $ <br />Zsp <br />SUBTOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTAL FEE $ <br />_ <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 />3�o �s <br />w �S <br />�09 y1/ <br />USE TONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />----- -- <br />T <br />—___ <br />TYPE Of COMES ALLOWABLE <br />TYPE OE CONSI ACTUAL <br />ntcpvucr <br />_ <br />No WpwHUNdwns <br />PLUMBING <br />LxMr <br />SIZE OF BLDO <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />T <br />I <br />OCCUPANCY LOAD FIRE SPRINKLERS REO 0 HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />OTHER —t&. <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS PROVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />T— <br />7 7 sd <br />