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9Hfn <br />y � 3 <br />Ei n <br />H <br />Cx0 <br />� O H <br />z <br />Oyu <br />9Hzz+9 <br />t H H <br />8 co <br />H <br />(]rGqJn T <br />L*1 <br />H En <br />HOCAI <br />I <br />L ' <br />I 1 <br />Lf <br />I.I <br />L ' <br />APPLICATIOWFOR CONSTRUCTION PERMIT I'' "'" <br />TO BE COMPLETED It: INK -PLEASE PRINT <br />TM. E wry..•.... <br />CITY Of <br />everett <br />HEATING <br />6vS7EM: <br />UGAS <br />ELECTRIC <br />1, - <br />BUILDING DEPAH 1 MI N I <br />-- <br />259.8810 <br />DEMOLITION COMBINATION <br />BUILDING <br />KMECHANICAL X PLUMBING SIGN <br />01ANEq IMII ADDRESS <br />LITY <br />21P <br />PHONE <br />r <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />PHDNE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />�N.E\RILL fn�Ni TO1R IL ADORE55 <br />CI(Y <br />�E �RT <br />�j <br />ZIP <br />y <br />PpNO�N.E L E/lN <br />�{J l/f77� <br />A // <br />-f �'!L <br />�'/ /( nt"L M!1 jIT. y/✓ <br />AIY /91K <br />7�Ld <br />.Y <br />r <br />MECHANICAL CONNTTRACTOR MAIL ADDRESS <br />CITY <br />LP <br />PHONE LICENSE <br />PLUMBING LONTFUCTUR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />A, ren AnnM RFPAIR IIIFMOI ITION <br />INSERT BUILDING RELOCATION <br />CONTRACT PRICEOF Wosr I/ dOv/M-= <br />CONTACT PERSON AN HONE/ENO <br />WORKNO SQUARE FOOT INVOLVED,`�9, w <br />KDESLRId[E <br />RiN/ J- <br />PROPOSEDUSEOFUTADING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />r1l."fe gw o /y <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />-LenAL ER BELOW OR ATTACHFWRCOPIESI <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />gIPrKIN OF PROP ISNOWN <br />WORK WILL RE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOI_ BLOCK OF _ <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />c� <br />7 <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIR 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 />�AA <br />6 TURE OF CONiRACT011011 A1:•l•ORIZE�OjAGENT DATE <br />-"l�- <br />S UCI N` I '. I AND R'ISINESS NAME <br />A L 'A S LaIll <br />PROJECT A DRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />/S�' <br />AC AHNDLGUNITS—H.P. <br />L <br />BATHTUB <br />/O <br />FORCED AIR SYSTEMS—S.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />/ S", <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 6 DISP <br />S' <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />S ' <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />O ' — <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />OAS PIPING <br />' <br />_ <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />_ <br />r <br />' <br />SUB TOTAL S <br />' <br />SUB TOTAL $ <br />/D <br />PERMIT S <br />I <br />PERMIT $ <br />I <br />TOTAL. FEE $ <br />TOTAL FEE $ <br />Ild <br />FRONT `I ❑3fIKl <br />REARSELNC <br />SIDE SETBACK <br />R <br />PANOLK NUMBER F to.aa— <br />RECEIP7O <br />-7l <br />w <br />20 <br />SR <br />USEZ <br />LOTAREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />BUILDING <br />I <br />Si7 o0 <br />i <br />d <br />l—Z <br />TYPE V WNTS ALLOWABLE <br />TYFE OF CONST ACTT <br />A <br />,wm <br />I� <br />_ <br />PLUMBING <br />NO OF STORIES BASEMENT <br />OF BSA <br />MECHANICAL <br />Q ' 00 <br />{ <br />R <br />' <br />OCCUPANCY LOAD FIRE SPRNKLFRS RE MEKINT LIy4L17�TION <br />ADDITIONAL PLAN CHECK <br />O / 3 <br />OTHER <br />' <br />j,(D v <br />REASOWFOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />, <br />y I <br />INTAKE BY <br />PLANSAPP//9'DVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />��:00 <br />LOCAL SALES <br />I, G�2s <br />TAX CODE IS305 <br />TOTAL <br />�7�0 ;�j <br />ca. <br />Il. <br />