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APPLICATION FOR CONSTRUCTION <br />PERMIT <br />the Ererpreen PvereU <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK — PLEASE PRINT <br />MINE MMAIL ADDRESS _ / pTY ZIP /'PHHONE [� <br />TENANT /'L1.S � 1'/� �•Q� �IIAL/V %I� L-I�e�L.C�� 70 iL/ �.57-e /y <br />MAIL ADDRESS CITY ZIP PI ONE <br />APGHRECI OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE UCENSEA <br />C'c^n/ST Co y I2f� /t/i✓ Sc�77 J,�/77 ���- 9 <br />MECHANICAL GONTRAGTOn MAIL ADDRESS CITY 21P PHONE LICENSE IT <br />MBINGCTORONTRACMAIL ADORERS CITY 21P PHONE LICENSER <br />PLU <br />'II CLASS OF WORN <br />�' � ❑ REPAIR ❑ DEMOLI � WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />I <br />3 <br />❑ NEW ❑ ADDITION ALTERATION <br />TENANT IMPROVEMENT UR INTERIOR REMODEL ONLY <br />CONTACT PERSON AND PHONE NO <br />el <br />�s� U U <br />r> n <br />CONTRACT PRICE OF WORK :iN� nsfirr,<iy <br />DEBCRIBE WORK AND SQUARE FOOtAGEINLLi$ <br />�Q/(eol'a <br />W+oPoseO USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />J �'�� CT� <br />J <br />MEOW <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WH ETHER SPECIFIE D HEREIN OR NOT, THE GRANTING OF A PE RMIT DOES NOT <br />LEGAf�ESCRIRiIONOFPROPEERTY OR ATTACH I OURGOPIE51 <br />� <br />'i <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />BLOCK OF _i <br />ANY07HERSTATE ORLOCAL LAW REGULATINGCON STRUCTION ORTHEPER- <br />LOT <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />C— <br />THIS PROPERTY T THEWORK ADE <br />TOHAPPLICATION M <br />EST STATE CONTRACTORS LAW 1827RCWAND <br />AND I COMPLY T WITH THE <br />296.200 WAC. <br />iYJ <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />Q y' <br />' / /J <br />Y <br />APPLICANTS Cl TY BUSINESS LICENSE NO AND BUS ESS NAMI <br />' i CEO <br />PROJECT ADDRESS/ •e'j 1 <br />^7714 a �, 5T- •• 77-O.4 <br />ICRM <br />PLUMBING /VA-A/.Fi <br />//sAL2T <br />/l MECHANICAL Ol✓F— <br />IN <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET)A/C—A/HNDLG <br />UNITS —H.P. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS —BT.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />— <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOFDRAINS— RAINLEADERS <br />EXHAUST FAN <br />— <br />SI NK (SERVICE — BAR. ETC) <br />- <br />SUBTOTAL $ <br />SUBTOTAL $ <br />_ <br />PERMIT $ <br />PERMIT _$ <br />TOTAL FEE $ <br />FRONT SETBACK REAR SETBACK SIDE SETBACK <br />TOTAL FEE $ <br />PLANCHECKNU BERM O�J FEED RECEIPT NO. <br />�1 / <br />� <br />USEZONE <br />LOT —AREA— <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />0 YES ❑ NO <br />BUILDING <br />------- - <br />--- - — <br />IRS <br />ice_ <br />TY PE OF CONST. <br />OCCUPANCY GROUP <br />NO.OF DWELUNO UNITS <br />ALLOWABLJACTUAL <br />K/A <br />PLUMBING <br />SIZE OF BLOC <br />NO. OF STORIES <br />ITS - <br />❑ Y <br />GLOAD <br />MECHANICAL <br />— <br />OTHER <br />❑N <br />\ <br />N. Ht LIMITAl10N <br />v <br />FIRE SPRINKLERS REQUIRED LYES 11 NO <br />STATE BUILDING SURCHARGE <br />Jo — <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATIO�N�.AI'C PlpN9 A/1/P�3J,B�Y <br />TOTAL <br />