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cliH <br />H <br />�Hy <br />rye 0 <br />H0 <br />V! FIU <br />N1-3 <br />H <br />8 t7 <br />OH <br />N@8 <br />(yyi Y n <br />t" y <br />HH <br />gy <br />O C7 In <br />1+1 <br />HOti <br />rl <br />Ll <br />1 <br />Lf <br />I+,I <br />APPLICATWI t "l FOR CONSTRUCT :,bN PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />Me Ew glom <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />I I DEMOLITION I I COMBINATION <br />HEATING SYSTEM: L-' GAS ❑ ELECTRIC U <br />everett <br />e <br />BUILDING I I MECHANICAL 1 1 PLUMBING l SIGN <br />yITV Zip PHONE <br />e7RZOI 252-.3735 <br />ARCHRECTORDESIGTIER MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />FOR RAE CONIRACTOR MAIL ADDRESS �✓ <br />-le (c%t�cI C�7Z5�. plc/ <br />CIIY J/ ZIP <br />S ZU9—YST �/C <br />PHONE <br />/�i� a5a <br />LICENSE <br />�i73 BKST�Pc/S/K. <br />1 + +' °( ,t�uT <br />ZIP <br />PHONE <br />LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDHES <br />CITY <br />CITY ZIP <br />PHONE <br />LICENSE• <br />PLUMBING CONIRACTOR MAIL ADDRESS <br />1� <br />CLASSOF WORK I I ,.,.,., I I wnnncrnvrirRPL INSERT Fl BUILDINU RELOCA ION <br />Pei NEW I I AUUIIIUIN I I HLlcnnnvr, ,. . '- <br />E3.� 0 <br />`pt <br />".__.. <br />C T CT PERSONA D PHONE N0. <br />c,w0Crpnlceor '`7/D(n/, t�-s� <br />eue Dui Ids q5a-a�73 <br />wonK <br />DESCRIBE WORK AND SOUARE f00 AGE INVOLVED <br />a61 INS ar r� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF UILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />nall or, sL �- <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DfSCRIPNON OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) p <br />71 I I <br />HETHHEREIN <br />PRIESUME TO GIVE <br />WORKLOT <br />385 / <br />BLOCK OF L V U! Y <br />NOT. THELGRA TANG OF AD PERMWITH IT DOES DO S <br />OR CANCEL THE PROVISIONS OF ANY <br />( <br />y.JO - 3&'S _ UO / -" OOO Z <br />AUTHORITY TO VIOLATE <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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR ON AUTHORIZED AGENT DATE <br />�OZG l7.Lc.<- <br />p % <br />X_/7"17 <br />t /75141 l3-/K Sfee! ,6(c/g l'DxSz`, <br />PROJECT ADDRESS E <br />/1/��o = e <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />9o/ ae <br />PLUMBING <br />FEE <br />MECHANICAL _. <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />r— <br />A/C—A/HNDLG UNITS—H.P. ' <br />WATER CLOSET (TOILET) <br />FORGED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) _ _ <br />UNIT HEATERS—B.T.U. M <br />' <br />SHOWER `— <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP _ �_ <br />VENTILATION FAN --� <br />RANGE HOOD <br />DISHWASrIER <br />LAUNDRY TRAY <br />�— <br />TER <br />_ <br />CLOTHES WASHER <br />VE <br />FIREPLACE 8 CHIMNEY <br />— I— <br />URINAL <br />DRINKING FOUNTAIN <br />i <br />INSERT <br />WNSEF <br />' <br />—FLOOR <br />_ <br />DRAIN <br />BACKFLOW PREVENTERS <br />— <br />_� <br />ROOF DRAINS—RAINLEADERS <br />AN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />— <br />PERMIT $ <br />PERMIT $ <br />�— <br />TOTAL FEE $ <br />TOTAL FEE $ <br />�... <br />FOR OFFICt U51t <br />FRONT SETBACK <br />—�� <br />USEZOTIE <br />-� <br />UNLY: <br />REAR SETBACK <br />, <br />LOTAREA <br />SIDE SETBACK <br />5Ad_IpAF2�n1 <br />VACANT SIZE <br />NO <br />PLAN CHECK NUMBER <br />�'13�J.3 <br />FEES <br />FEE <br />y�•.�U <br />VALUATION <br />,53/9s <br />FEE <br />,F- <br />8l UV <br />BUILDING5_0� <br />TYPE OI CONTS. ALLOWABLE TYPE Of CONSI. ACTUAL p[pwN♦ v,mmum mrs <br />- 3 QiTml) <br />PLUMBING <br />_T <br />SIZE OF BEEF; NO, OF STORIES BASEMENT <br />hlu <br />OGCUPAN YLOAO FIRE SPRNKLERS REDO FREIGHT LIMNAT1011 <br />�5 ' <br />REA )FOR SPRINKLERS NO <br />MECINNICAL <br />1_ <br />ADDITIONAL PLAN CHECK <br />J <br />OTHER <br />_--�— <br />STATE BUILDING SURCHARGE <br />JU <br />PUBLIC WORKS <br />—T <br />INIAK: BY <br />PLANSAP ROVED BY <br />1�21 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/ l <br />