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APPLICATION FOR CONSTRUCTIvN PERMIT <br />�pn.. e <br />TO DE COMPLETED IN INK —PLEASE PRINT <br />2Pb <br />�7 V. <br />RM <br />i N <br />�F°atr�y�y <br />O m <br />'-' <br />N9 Evergreen <br />CITY OF _ <br />everett HEATING SYSTEM: JGAS ❑ELECTRIC ❑ --_ <br />BUILDING DEPARTMENT <br />259-8810 <br />_DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />MAIL ADORE'J �S _CITY ZIP PHONE <br />OWNER Z a( <br />e? <br />r <br />r <br />TENANT <br />°� <br />IL DRESS <br />ADMA <br />2HO6 <br />li�i%lsi�t° <br />CITY <br />nn� <br />21P <br />PHONE <br />rn <br />ARCHITECT OR DESKiNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />P MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />ii PLUMBING CONTRACTOR <br />MAR ADDRESS <br />— <br />i <br />GLASS OF WORK <br />wMncmvF/FRPI INSERT <br />BUILDING RELOCATION <br />NEW (ADDITION ALItHAlwry <br />._ <br />--- ._.. .-- <br />/U/ <br />NTACT PERSON AND PHONE NO. <br />=d <br />)0�zJ06 <br />CONTRACT PRICE OF WORN <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />euILDwG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSE USEO <br />APPLICA"ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />C �2 <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />n <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPE9TY 10 PERFORM THE WORK FOR WHICH <br />THE STATE <br />1 / / <br />A,0 Q� �O7 3 (¢S �i9� d0 <br />APPLICATION IS MADE AND I COMPLY WITH <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�E /f n J- D <br />Jr OVA <br />II <br />�� <br />i <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X _ <br />A� <br />APPLICANTS CITY BUSMESS LAC NSE NO. PN BUSINESS NAME <br />*f -003 -aova09 <br />PROTECT ADDRESS <br />/ <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />AjC-AIHNDLG UNITS -HP. <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS-B.T.U. M E.A. --'— <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />_ <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />-� <br />DRINKING FOUNTAIN <br />I <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />i <br />I <br />I <br />1 <br />i <br />T <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE <br />TOTALFEE $ <br />' <br />( //. 70AwltG C(I . <br />FOR L)FFIGt Uat <br />FRONT SETBACK <br />UnLT: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CM KNUMOER / ^� <br />RECEIPT NO <br />uSEzoNE <br />TorAflea <br />VACANTSITE <br />FEES VALUATION <br />FEE -� <br />I <br />Z-S <br />Door% <br />^loBoG <br />BUILDING <br />!r 0 <br />TYPE OF COATS. ALLOWABLE <br />TYPED CONST ACNAL <br />CCCxuvl'V <br />MItl VAiulAn urns <br />PLUMBING <br />—� <br />— <br />.� <br />� <br />MECHANICAL <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />G72 sP <br />Itio <br />OCCUPANCY LOAD <br />' FIRE SPRNKLERS REOT) <br />HEIGHT LIMITATI A <br />Np <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE. <br />Jib <br />INTAKE BY <br />PUNS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />1G o ;`� <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />