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APPLICATIO�i FOR CONSTRUCT�N PERMIT everett <br />a„ E,,,,o,,,,, TO BE COMPLETED IN INK—PLEASE PRINT � <br />atv oF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />O MAILAUDRESS <br />��1"vlo�7 Cn�uSU/�✓ <br />TENANT MAILADDRESS <br />�C G M n. R K G,r' �� <br />ARCHITECTOflDE51GNER MAILRODRESS <br />t=! BUILDING <br />CITV <br />f_�-MECHANICAL <br />Z:P Pf <br />� �,��,,r e,�r <br />ZIP PMONE <br />.UG2rTi <br />ZIP <br />L PLUMBING u SIGN <br />GENERALCONTRACTOR MAILAODqESS CITY 21P PHONE �ICENSEI <br />MECHANICQCON7iUCTOR MAILAUDHESS qTV IIP PHONE LICENSEI <br />��fG%� SOn/ �d f� �llT. /n/�!• '�-O,ZI'�l– �Cco4R n t /2S L ni L�n00 9$b �e <br />VLUMBINGCONTRACTOR MAIL�DDRESS CITV ZIP PHONE LICENSER <br />r-,e« a� 2�:zc7 <br />CLASS OF WORK <br />❑ NEW '❑ DITION ❑ ALTERATION ❑ REPAIR C DEMOLITION ❑ WOODSTOVE/FRPL INSERT G BUILDING REL�CATION <br />/ / I`1,0C� �_t n V I CONTACT PEflSON ANO PHONE N0. <br />-. s /'� g <br />V CONTRACT PRICE OF WORK `�,�-�� � M I L U �(. �[,i ((�� S ON� <br />AND SOU�RE FOOTAGE INVOlVEO <br />� <br />rRowsen use oF euaoir� <br />�.a� /� 57`0 (�'. � T�u-' <br />LECu1L DESCRIPTION OF PPOPERT'f (SHOWN BELOW OR ATTRCH FOUR COPIES) <br />LOT BLOCN OF <br />� � �� � �VE.1 <br />PLUM8ING <br />NO. TYPE OF flXT <br />WATER CLOSET (TO�L <br />snniTue <br />LAVATORY (WASH BA; <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />:IRINAL <br />DRINKING FOUNTAIN <br />FLJOR DRAIN <br />I ;i00F DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SU8 TOTAL <br />PEAMIT <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK RERRSETBAI:K <br />USE20NE LOTAREA <br />iYPE OF LONTS. RLLOWABLE iYPE OF CONST AC <br />SIZEpF9�DG. NO.OFSTOFIES <br />OCCUPrWCV LOAf+ FIRE SPpNKLEfl; <br />HENSON FOR SPRINKLEflS <br />INTAKEBV � PLANSAPPROVEOBY <br />FEE <br />��s ��sy�� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE 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 ?7 RCW AND 296200 WAC. <br />SIGNATUNEOFCONip�LTORORAUTHOflIZEOAGENT DATE r(il/p/�j� <br />' Y� � ' 7/I.cl t <br />APPLICANTS Bl1SINESSUCENSENO.ANUBUSINESSNAME <br />NO. j TYPE OP E�UIPAAENT I FEE <br />Al�A?iNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNiT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUfdP <br />GAS PIPING <br />EXHAUST FAN <br />$ <br />$ <br />$ ' <br />SIDE SETBACN PLAN <br />VRCANT SITE <br />BUILDING <br />9CCUF.IIW.'Y NOWPMIIiNGUNRS <br />�pWP PLUMBING <br />BASEMEN7 MECHANICAL <br />MEIGM7 LIMITATION ADGITIONAL PLAN CHE: K <br />_ O7HER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES - <br />TAX CODE IS 3105 ror�� <br />SUB T.TAL $ �(J � -- <br />PERMIT $ , � <br />TOTAL FEE $ � 5 � — <br />RECEIPT NO. <br />i <br />