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k UC,> �� Clint Carnell Owner
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<br /> tt(�� >� Ui Huseby Associate f l
<br /> � p'�, cs s ` IA rna+, ' ,�° I' . UU; , ` STRUCTION PERMIT everett
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<br /> the Evergreen u ) �G,�� I' IMPRESSIUN'DESIGN' k—PLEASE PRINT
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<br /> CITY OF j It''ll,1 Ao,,I s. i� i 1 Draftin
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<br /> �n , ,� . o. I`, .AS ❑ ELECTRIC ❑
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<br /> BUILDING i eV ; '. 'i + . _;,� =I+k,= , t I i
<br /> 259 8810 'i +'2418'CA�1 drnia A"ve I��� `';
<br /> # t, , +r s i 2 g, + I Office 252 9200,
<br /> ❑ DEMOU= f e to t%s t41 0,..61:4 # t44 Home 337 3200 I_:l MECHANICAL CI PLUMBING [1 SIGN -
<br /> O NER ___ ZIP PHONE
<br /> • � ? / Z.-- 7O26 yy-° /5 a) -vi 9rr<vos .,., �- 7yg f
<br /> ENANT MAIL ADDRESS CITY ZIP PHONE
<br /> 'Zs!>13/Ze'$ /(0 ) <TV 4,✓ cP ci/1 ( 6 L- t'% 4 o) 41 - �Ia DD
<br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE
<br /> . 1"s;,4-P ` �7`-'" - t'C /PC'-')< /sY 4-75-td t'f 9t2 7o ,ass— 24P 9
<br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE it
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<br /> MECHANICAL 6ONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE#
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<br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE it
<br /> CLASS OF WORK
<br /> Ip( NEW L1 ADDITION LI ALTERATION L.1 REPAIRA LI DEMOLITION I 1 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION
<br /> '> /oCL�/ '7'7 3CT PERSON AND PHONE NO.
<br /> DESCRIBE WORK CONTRACT EAND SQUARE FOOTAGE INVOLVED OF WORK /�D v /�/ •
<br /> Lind_Apt"; etl--e-1 4 Ifit0c4 c .07fIZO Al
<br /> PROPOSED USE OF BUILDING ,/ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS
<br /> s�pNf74 k.¢1N f` d47i.L� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL
<br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF
<br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR
<br /> LOT 9 BLOCK OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE
<br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY
<br /> ,C�tll y� L G �� / 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 /> CONTRACTORSLAW :.27 'CW AND 296.200 WAC.
<br /> SIGNATURE OF CONTRACT',••• / 9 sT�.�esZe
<br /> /HHCP,.+' 4 A NT DATE ` ///J
<br /> / v ,1St'1 ✓ 1...�4/l/SF-
<br /> COO 1/ , 5 ,� i N4/�� ^ //2- . .v —
<br /> PROJECT ADDRESS ' ��'',
<br /> APPLIC' TS CITY BUSINE S LICENSE NO.AND BUSINESS NAME
<br /> PLUMBING MECHANICAL
<br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE
<br /> -,,:tWATER CLOSET(TOILET) i A/C-A/HNDLG UNITS-H.P. ,F s 4
<br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M t.A.
<br /> LAVATORY(WASH BASIN). UNIT HEATERS-B.T.U. M /95 /2ey'f
<br /> "/ SHOWER CLOTHES DRYERS •J
<br /> / KITCHEN SINK&DISP VENTILATION FAN ✓
<br /> 7 DISHWASHER RANGE HOOD j/
<br /> LAUNDRY TRAY WATER HEATER ,/
<br /> / CLOTHES WASHER WOOD STOVE
<br /> . URINAL METAL FIREPLACE&CHIMNEY
<br /> DRINKING FOUNTAIN FIREPLACE INSERT ✓
<br /> ..-- FLOOR DRAIN HEAT PUMP
<br /> BACKFLOW PREVENTERS GAS PIPING 1/
<br /> /41 ROOF DRAINS-RAINLEADERS EXHAUST FAN
<br /> .- - SINK(SERVICE-BAR,ETC.)
<br /> SUB TOTAL $ SUB TOTAL $
<br /> PERMIT $ PERMIT $
<br /> -
<br /> TOTAL FEE $ TOTAL FEE $
<br /> FOR OFFICE USE ONLY:
<br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO.
<br /> 27,30& 693,/3 ,f3l4'
<br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE
<br /> BUILDING
<br /> TYPE OF CONTS.ALLOWABLE TYPE OF CONST.ACTUAL OCCUPANCY NO.OF DWELLING UNITS
<br /> GROUP - PLUMBING
<br /> SIZE OF BLDG. NO.OF STORIES BASEMENT MECHANICAL
<br /> OCCUPANCY LOAD FIRE SPRNKLERS REQ'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK
<br /> OTHER
<br /> REASON FOR SPRINKLERS
<br /> STATE BUILDING SURCHARGE
<br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS
<br /> LOCAL SALES
<br /> TAX CODE IS 3105 TOTAL
<br />
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