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0 1 <br />'! APPLICATION FOR CONSTRUC"lli PERMIT everelt <br />me EreFgronn TO BE COMPLETED IN INK—PLEASE <br />PRINT �,.►.//J (� <br />CITY OF 7 Pw rt ✓ I f ) c • I � hiii IT c tr / <br />everett HEATNG SYSTEM: IJ GAS Ll ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL 1]tPLUMBING SIGN <br />OWNER AIAILADLRESS G 0 Hoe eltA . `F V w L- '� rHONE 3 t1$- <br />5W moMI.04 CpUNT4 -2N19 FLA 1+0" N_ r'NEJL <br />IENANT MAILADDRESS 300� �or✓KEtIIEC�.E'C, E�-E'i�WAs `MZoj <br />SNvf�Ll rt I sg COunLT�—�l1GT >>1F F�L/La/ N6 ra FLavAe Ca I'�dt <br />ARCHITECTCRDESIGNER MAILADCRiss City ZIP PHONE Zsz-ZIS3 <br />GA2k PM�KINAOILI e-�it� �Z�lZ cal Bpi r4�1E. 43z Via- 982.a1 <br />GENERAL CONTRACTOR MAILADDRESS CITY ZIP PHONE SEI <br />roo cOan� �,>✓u rC GavS z. P. u, Box -1 6 1� AeA--T E LUAA 9812% - u, s•r Iwo <br />wASf+INGYvr� HEciht4NC t-4nri /3nW P/kfF>��/I Nwn �f,,00• 10ENSEI <br />�o,/'-Glt�l7MECICMAILADDRESS ZIP PHONE �s <br />so SC� <br />CITY IE�Q <br />JUC RISTEN <br />PLUMBING CONTRACTOR MAILADDRESS S wAIN/NG[yJ ��{(fLttJLCA�Cit1NT�'t—" 1�f 2Z3�UJ-Lt�9-Sk-/N- <br />cuss of wonK C Z 7Sf1A <br />/.. _.....�...� DUDAID npmr)i ITInN WOODSTOI'E/FRPL INSERT BUILDING RELOCATION <br />— <br />CONTACT AND PHONENO <br />- <br />APERSON <br />Ll OR'f� �` • T'�`�a_rl ^ �", `'A1 N f 7 <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOIVED <br />/ <br />PROPOSED USE OF BJILDING Ci LTN-17, 1 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�A •�f U u f <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />THIS TYPE OF <br />—cV <br />LEGAL DESCRIPTION OF PporERTV (SHOWN PELOW OR ATTACH FOUR COP¢SI <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING <br />WORK WILL BE COMPLETED WITII WHETHER SPECIFIED HEREIN OR <br />LOT_ BLOCK or <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />U� (�_- <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTI,ORIZED 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 WAG. <br />SIGNATURE OF COIIiRAC10R ROA OR AU11101117ED AGENT DATE <br />x �wHc- <br />O�sctitPzfc�r`,— — <br />PROJEUT ADDRESS <br />-' <br />APPLICA14TSC BUSINESS LICENSE NO AIO BUSINESS NAME <br />nn <br />Is <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC-NHNDLG UNITS-H.P. <br />BATHTUB <br />-��• <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />C <br />LAVATORY (WASH BASIN) <br />'i� � <br />UNIT HEATERS-B.T.U. M <br />—r— <br />J-� <br />i• <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KSP <br />ITCHEN SINK & DI <br />— <br />�_ <br />VENTILATION FAN <br />_ _ <br />—;— <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />i <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />'' './' <br />METAL FIREPLACE & CHIMNEY <br />Z. <br />DRINKING FOUNTAIN - �I <br />—ICE <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />yr <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />r� <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) .-ii <br />-- <br />; <br />z <br />- s{,ilE STl c /F,T cU�z GT1i�lIL <br />�Q <br />--T— <br />iJoNFl`rrc II. LLA..�lSL.f�ttffA <br />S'� <br />— <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT 5 <br />l—Fo <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE S <br />FRONT SETBACK <br />V•FEAR SETBACK <br />SIDE SETBACK <br />°LAN CHECK NUMBER <br />ILE <br />RECOPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />TYPE OF COtITS ALLOWABLE <br />TYPE OF CONST ACTUAL <br />B(DIr+N[r <br />Ao doalwwc uNnS <br />� <br />cAwr <br />PLUMBING <br />-- <br />SIZE OF SLOG <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD F mF SPRNKLERS REOD 14EIG11T LIMIIAI ION <br />I <br />OTHER <br />--.—tom <br />REASON FOR SPRINKLERS <br />— <br />STATE BUILDING SURCHARGE <br />INTAKE SY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />1 TOTAL <br />