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• � APPLICATId�I FOR CONSTRUC7.JN PERMIT everett <br />tne Everyreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITY OF <br />eve rett HEATING SYSTEM: � GAS � ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />' DEMOLITION i_=: COMBINATION X BUILDING X MECHANICAL X! PLUMBING 1 SIGN <br />OWNER MAILAOORESS GITV ZIP PHONE <br />Alderwood Water District 3626 156th Street SW Lynnwood. WA._ 98036 743-4605 _ <br />TENANT MNLADDRESS CITV ZIP PMONE <br />ARCHITECTOROESIGNER MAILADDRESS CITV ZIP PNONE <br />James M Montgomerv 2375 130th Avenue #200 Bellevue WA. 98005 881-1100 <br />GENERALCONTRACTOR MAILADDRESS GTY ZIP PHONE ��CENSEM <br />IAECHANICALCONTRACTOF �AAILAUDRESS QTV 21P PHONE LICENSEM <br />PLUMBING LONTRACTOR MAIL ADDRESS CIN ZIP PHONE ��CENSE I <br />CLASS OF WORK <br />'X NEW Ci ADDITION �! ALTERATION ❑ REPAIR C�I DEMOLITION �' WOG�SiC1'FJFRPLINSERT ❑ BUILDIN�RELOCATION <br />I CONTACT PERSON AND PHOhE NO. <br />CONIRACTPRICEOFWOFK� � <br />DESCFIBE WORK AND SOUARE FOC <br />Construction of new <br />PflOPOSED USE OF BUILDING <br />Water System Pump <br />LEGAL DESCRIPTION OF PROPERTY <br />LOT BLOCK _ <br />PROJECT ADDRESS <br />TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY(WASI <br />KITCHEN SINK 8 <br />DISHWASHER <br />CLOTHES WASHER <br />si Yum �tat;on nia . cuo aai-iiuu <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�n APPLICATION AND KNOW TFIE SAME TO BE TRUE AND CORFiECT. ALL <br />BELOW OR ATTACM FOUR COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COM?LETED WITH WHETHER SPECIFIED HEREIN OR <br />_�F NOT. TH[ GI3ANTING OF A PERMIT DOES NUT 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 T�HE STATE <br />CONTRACTORS LAW 1827 RCWQ,a ANp 296.200 WAC. <br />SIGNAT��QcnoY�.�nc�'�a�e�"V�z��r+r DATE ��/�/y,D <br />�• <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK ISERVICE—BAR, ETC <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFIC� USE ONLY: <br />FRONT SETBACN flEAR SETBACK <br />USEZONE LOTAREA <br />�^ � <br />iYPEOFCONiS.ALl4WFBLE iYPEOFCONST.ACIOAL <br />��� �) �� <br />SIZE OF BLDG. NO.OF STOflIES <br />1 5,�. I <br />nCC11PANCV LOAD FIRE SPRNK�ERS REO'D <br />FOfl <br />INTAKE 6Y <br />X ��. �����N� � <br />APPLI NTS BUSINESSIICENSENO.ANDBU51NES5NAME <br />FEE N0. TYPE OF EQUIPMENT <br />� A/C—A/HNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />� RANGEHOOD <br />SIDE SETBAGK <br />VACANT SITE <br />aeuP+ver xoo�owewxeurnrs <br />nour <br />BASEMENT <br />N � <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />WOOD STOVE <br />A7ETAL FIREPLACE 8 CHIMNEY <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST F� <br />PLAN CMECK NUN <br />�'o /��i <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />SUB TOTAL S <br />PERMIT $ � <br />TOTAL FEE $ � <br />FEE RECEIPiNO. <br />�?�s a�" y�yoa <br />VALUATION FEE <br />i <br />Z � <br />i <br />i <br />i <br />i <br />