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� APPLICAI O�1 FOR CDNSTRU�. r10N PERMIT everett <br /> TO BE COMPLETED IN INK—PLEASE PRINT � <br /> t�s Evergreen <br /> CITV OF <br /> everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ ���� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBIA�ATION BUILDING MECHANICAL PLUMBING SIGN <br /> WNER MAILAUDRE55 QTY IIP P/IONE <br /> ,��,�1 �yav��F/� ��o�l Y� G v�;��7 9�� � �sa-�s�i <br /> TEN�N7 4AILADDRE55 �"` <br /> �J�C- <br /> AqGHITECT OR OESIGNER MAIL�DDRE55 /J CITV ZIP PMONE <br /> �W A/G �Ic. � .k� C<s�- /J.Cf �]�-: <br /> GENEPALGONiR�GTOR MAILADORESS /CITV iF VNCNE LICENSEt <br /> '!1 w u�,� �O A1 o L=-a L7N� <br /> —�•1- GITV IIP PNONE LICENSEI <br /> MEGH�NIGALCONTRACTOA MAILADDRESS <br /> 0/✓ � <br /> PLUMBIN3GONTR�CTOR MAILADORESS GITY ZIP PNONE LICENSEt <br /> C1A550FWONK I <br /> �-' NEW ` - ADDITION � � ALTEFATION �. . REPAIR �CDEMOLITION . �. WOODSTOVEIFRPLINSERT '_ 6UILDINGRELOCATION <br /> CONTRCT PERSON AND9PHONE NO. /� l <br /> CONTR�CT PRICE OF WORK I�GC{Yti/ -AA'UN/rt- �S d�-7SlI <br /> UESLRIBE WOPK AND SOUARE FOOTAGE INVOLVEO <br /> �ru=o �, s�- <br /> PPOPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> - APPLICATInN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN�ELOW OR ATTACH FOUR CAPIESI PROVISIONS OF LAWS AND�RDINANCES GOVERNING THIS TYPE OF <br /> p _ WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br /> tot BLOCN l� oF U�(/- .v Y�b NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OF CANCEL THE PRUVISIONS OF ANY <br /> � �V�z�� OTHER STAlE OR LOCAL LAW REGULA.TING CONSTRUCTION OR THE <br /> FERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT�ON IS MADE AND i COMPLY WITH THE STATE <br /> CONTRACTORS LA�V 1827 RCW AND 296.200 WAC. <br /> SIGNATURE OF CONTRACTON OR�UTHORIZE�Af,ENT DATE <br /> X �a �.��.IA L.w �� ��j <br /> PP0.IECT�ODRESS -- <br /> ^J �� ^�`�� �j% APPLICAhTSCiTVBUSINESSLICENSEN . DBUSMESSNRME <br /> S t <br /> PIUMBING MECHAHICAL <br /> NO. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � /UC—AlHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR S`.'STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS � <br /> KITCHEN SINK 8 D�SP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 ChIIMNEY � <br /> DRINKING FOUNTAIN FIRcPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PRtVCN RS GAS PIPING � <br /> ROOF DRAIN5—R LEADERS � EXHAUST FAN <br /> SINK(SERVICE AR,ETC.) <br /> i <br /> i <br /> -�_ <br /> � <br /> SUB TOTAL $ ; SUB TOTAL S ' <br /> PERMIT $ PERMIT S <br /> TOTALFEE $ TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> IRONTSF.TBRCK REARSETBACK SIDESETBACK PIANGHECNNUMBER FEE REGEIPiNO. <br /> USEZONE LOTAREA VRCANTSRE FEES VALUATION FEE <br /> I <br /> BUILDING �_ <br /> iY�C Of CONTS./�ILOWABLE n'PE Of CONST.ALTUAL OtCumN[r xo p VxFLliN4uNu5 � <br /> cnwv PLUMBING <br /> � <br /> SRE OF BLOG. NO.OF STO(iIES BASEMENi MECHANICAL <br /> i <br /> OCGUPANCY LOAD FlRE SPRNKLERS REO'D HEIGMT LIMITATION ADDITIONAL PLAN CHECK �� <br /> OTHER <br /> REASON FOR SPPINKLEPS <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS RPPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAI SALES �� <br /> TAX CODEIS 3105 TO7AL ; J <br />