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P <br />L <br />X <br />APPLICATIJN FOR CONSTRUG . ION PERMIT <br />E VBFBiI <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Ewrgr eR <br />CITY OF <br />eve rett <br />F HEATING SYSTEM: ❑ GAS <br />j ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />G-COMBINATION BUILDING <br />MECHANICAL PLUMBING <br />SIGN <br />OWNER <br />MAIL ADDRESS CITY <br />J <br />ZIP PHONE <br />3 It 1 c. <br />2-:,Lk LI tr (&ICE&f <br />TiNM1T <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />_ rJ �- <br />ARCHITECTORDESIGNER <br />MAIL ADDRESS CITY <br />SR <br />ZIP PHONE <br />She- <br />RntFs CG��� c2 <br />r�. u/ Q <br />GEN AL CONTRAC OR <br />�l. <br />ELE� orUS% <br />MAIL ADDRESS CITY <br />i3t2c oed _5W0 S�'e <br />utw <br />ZIP 10NE�EI7a <br />Y�2in ,SLR/6S/ L tc `> <br />C �7e <br />MCCHANICAY CONTRACTOR <br />MAIL ADDRESS U CITY <br />ZIP -T ENSE8 <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE LICENSF• <br />CLASS OF WORK V <br />NEW ADDITION ALTERATION ^ REPAIR DEMOLITION WOODS-OVE/FRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO <br />iu <br />CONTRACT PRICE OF WORK Ic rr-0 i <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVEDclal-r t -5Fe- <br />Ff=1�� <br />n -LJ7 l,, bl <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />l <br />Y t V F9Tf 0 _- _ <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY [SHOWN BELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />tot �L� Yt 13 BLO^.K OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />_ <br />1 <br />L- <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 />T .27RCWAAUTHORIZED AGENT DATE <br />CONTRACTORS LAW ROR RCW AND GENT 0 DATE <br />r <br />�I n <br />//''�� <br />YL - �/ ° L �i. 1-r <br />U �� <br />SIGNATURE CONTRACTOR <br />G� <br />PROJECT ADDRESS I <br />APPLICANTS CITY USINES!, LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />_ <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS--B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLO' J PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />LINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />ono Aoclre "CC nw V. <br />FRONT SETBACK <br />_AR SETBCK <br />SIDE SETBACK <br />PLlINDCHE .I: NUMBEFI <br />CF/=EES <br />FEE 3f7:) <br />VALUATION <br />RECEIPT NO <br />USEZONE ^"7 <br />C_ <br />LOTAREA/A w� <br />�ISL.V <br />VACANT::ITE <br />N c <br />FEE <br />BUILDING <br />TYPE OF CONTS ALLOWABLE <br />iFT_ <br />TYPE OF CONST. ACTUAL <br />'�- _ ^/ <br />OCCUPANCY <br />W� <br />I NO mOAHU"GCNITS <br />�+- <br />PLUMBING <br />I <br />SIZE OF'B,LDG. <br />YL <br />NO. OF STORIE <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUP NCYYLOAD FIRE SPRINKLERS RED HEIGHT LI/MIIET/ATION <br />_ _ ND <br />R@$ON OR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />L �— <br />INTAKE BY <br />PL.NS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS3105 <br />PUBLIC WORKS <br />TOTAL <br />7�(�( 50 <br />