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1 <br />1'\L'IV(I <br />,Q►PPLIC�►TIQ : A FOR CONSTRUCT, JN PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />Me Evoween <br />CITY OF <br />everett E <br />BUILDING DEPARTMENT <br />259-68111 <br />AA <br />DEM'JLITION .COMBINATION <br />OWNER MAIL ADDRESS / <br />xrI-n <br />may <br />,oxx <br />C Hi <br />>�3N <br />rx <br />I-+>3 <br />3Zn <br />He Hx <br />0 <br />wr <br />xZ3 <br />t7 3 lz 7 <br />HC7 <br />MO8 <br />9 A <br />to Z <br />Hl 3 <br />H3OEn <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑C <br />BUILDING <br />ZIP <br />CIT`. T— ZIP ' PHONE <br />PLUMBING _SIGN <br />GENER LCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br />ulnnnernUFIFRPI INRFRT BUILDING RELOCATION <br />NEW -_. ADDITION ALItHAIIUrv- <br />CONTACT PERSON AND PHONE NO <br />�c_^ <br />CONTRACT PRICE OF VrRK <br />DESCRIBE WORK AND SQUARE FOUTAGE'NYULLVED� <br />_ I <br />/ 70 <br />0 L <br />�E �IJ1T H WISH �IORI <br />F111'J1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEC THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />D _ oT <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF "iJPERIY ISNOWN BELOW OR ATTACH FOUR COPIE51 <br />O PRESUME TO <br />NOT THE VE <br />ANTING OF R PERMIT DOES <br />LOT_ BLOCK OF <br />THEPROVISIONS OF AT NY <br />VIOLATERCANCEL THE <br />TO <br />AUTHORITY TO <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 T::E STATE <br />CONTRACTORS LAW 18 27 RCW AND 296.200 WAC. <br />ZED AGENT GATE <br />SIGNATURE OF pNT ACT")o <br />X p <br />PROJECTADDRESS 1' , LTA <br />71 1 KIL ��e <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />MECHANICAL <br />PLUMBING <br />NO. TPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />WC -A HNDLG UNITS-H.P. <br />-EA <br />FORCED AIR SYSTEMS-B.T.U. M <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />' <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />- <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />; <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />_ <br />SINK (SERVICE -BAR. ETC.) <br />I <br />; <br />SUB TOTAL $ <br />SUB TOTAL $ <br />,JO ;on <br />T <br />PERMIT $ <br />I <br />PERMIT $ <br />/ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />J ' <br />FOR OFFICE USE <br />UNLY: <br />RECEIPT No <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />LOT APcA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />BUILDING <br />TYPE OF CONIS ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />pFCIJFAMY <br />Yo ttPMILINr.In�tS <br />PLUMBING <br />MECHANICAL <br />' Qv <br />STORIES <br />BASEMENT <br />SIZE OF SLOG, <br />NO. OF <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'0 [H:EIG1:1LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />NEASON FOR SPRINKLERS <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED By CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />(q5 <br />_.,h(Al <br />