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the Ewrpram <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />250•BB10 <br />APPLICATION FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />A <br />o"ARAM. VM.u. <br />PLAIT 5L,5c �'/c 61 01 /Oroos 3.W. AcL W 61W. A9091 VW PHONE <br />7005 sea <br />TENANT <br />MNL AODTIES6 CITY ZIP PRONE <br />gAME A5 ABOVE ALL 4a4CEsPtwoe+vCe 7v CL/!/lC <br />ARCHITECT ON DENONER MAIL AODRE IS GTY ZIP PHONE <br />�M Gov�RT PE 3/z NVV /o''^'AVL 111,E260�10-tvlfM7 209(sas�e-o�r�b <br />E MMLADDRES9 <br />GTY ZIP PHONE L NSE <br />"VE _►C0NTINID-i IAAA 4Q'JnG/2A/1 259-9/9/ UAvucaY3c <br />nwBNG cDNtaAc:oR <br />MNLADDRESS GTY ZIP PHONE LICENSE• <br />n <br />wa.RY I -I RUILDINDRELOCATION <br />NEW ADDITION ALTERATION <br />CONTACTPERSON AND PHONE NO <br />NMI NIP IMSNT OR INTERIOR REMODEL ONLY <br />C��i�t sn.v�e rc�►rr Ece. soa Gy1- 1z/ <br />CONTRACT PRICE OF WORK a/9000 <br />pS WORK ANDSOUAREFool INWJLVLD <br />h[:IJLNlJ AIsWLI1/1�q.� ���q <br />G EOKy6 n(��MrW O ST 6L�1 <br />W/Lt�//bu58 WITFFOFFK6 ¢ plaPuPY /OA S� s.F. <br />1HEREBYCERTIFYI'MATIHAVE READ ANDEXAMINEDTHISAPPLICATIONAND <br />USE orwlLaND <br />KNOW THESAMETOBETRUEANOCORREW RLL WS AND <br />WDWITH <br />pp <br />KWILL BE <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />OAL D1f'9GPIPTKIN OF ppOPFRTYISHONN BELOW OR ATIACN FOUR COPE@ <br />WHETHER SPECIFIED HEREIN OR NOT.THEGRANTINGOFAPERMITDOEBNUi <br />PROVISIONS <br />PRESUME <br />J� OipLpCR�� DF i{iE. Pu9T r�F J_�. 51 ES <br />ATE OR LOCAL LAW EGULAFING CONSTRUCTION OR PER- <br />OF <br />LOTP <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />Aacs 1IZI�GTS LYING ��L� of �.I-L- <br />AND I COMP WITH THE STATE CONTRACTORS LNN 1827 RCW AND <br />296.200W <br />IZEDAGENT DATE—.��'�'o / <br />16EINW W VOLUMUS 4 of PLATS ON f►eA <br />�T—Q�AC7 QP SNoF <br />SIGNATURE TRACTOR AU I <br />X <br />3'7TM sT. eHo MoDo <br />CITY VVINNIL55 LICENSE NO. AND wSINEBB NAME <br />PROJECT ADDRESS <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />TYPE L)F FIXTURE OR ITEM <br />Np, <br />A/C —A/HNDLG UNITS —H.P. <br />WATER CLOSET TOR <br />FORCED AIR SYSTEMS — B.T.U. M EA <br />BATHTUB <br />UNIT HEATERS —BT.U. M <br />LAVATORY fWASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK { DISP. <br />DISHWASHER <br />LAUNDRY TRAY <br />RANGE HOOD <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE { OHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />—GAS <br />BACKFLOW PREVENTERS <br />PIPING <br />ROOF DRAINS — RAINLEAOERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC) <br />SUBTOTAL S <br />S!10 TOTAL $ <br />_ PERMIT $ <br />PERMIT S <br />TOTAL FEE S <br />FRONT SETBACK RCAN BEI MGK SIDE SETBACK <br />IOTAL FEE S <br />PLAN CHECK FEE��� RECEIPT <br />! 77 <br />USIZONE <br />LOT AREA <br />VACANT SITE <br />FEESFEES <br />VALUATION <br />FEE <br />BUILDING <br />ZCo9, �8 <br />-TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO.OF MELLING UNITS <br />—1 <br />µUMASLEJACTUAL <br />Q—Z <br />—_ <br />PLUMBING <br />SMEOra'.O0. <br />NQ Of 910RIE8 <br />Bsur. <br />DY <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />09 <br />_2_ <br />HEIGHT LIMITATION <br />STATE BUILDING <br />SURCHARGE <br />FIRE SPRINKLERSREOUIREO ❑ YES 00 <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />AIPLICATiON ACC BY PLANT APPN ar <br />A�c� <br />13 <br />TOTAL <br />