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APPLICATIG.. FOR CONSTRUVI @%#N PERMIT 4This EYP1gmAR TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett E HEATING SYSTEM: U GAS U ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />1 1 DEMOLITION I I COMBINATION 1( BUILDING I MECHANICAL I PLUMBING I I SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Ter FfW-1A.;Q Go - P.O. 901C 3707 fA3 OF-W., 15E47LS, wAl 99(q, 3VZ-rPO <br />CITY ZIP <br />S 4-Fn E Is o Ed N C A- <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />TAL1Lrl,j co 1 �►015 117� AVE W R-Lewcae-7r, if4 9YLeV Z90-9r79► <br />.......... .,.....,.�.nn uuI Annnccs CITY 21P PHONE LICENSE) <br />$Rrr Al< o Nov <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSED <br />CLASS OF WORK <br />-I .n Iv ., rro ATlnAI I I OPPAIA I i OFM[ll ITION ! I WOODSTOVE/FRPL INSERT I7 BUILDING RELOCATION <br />' "•• <br />CONTACT PERSON AND PHONE NO <br />�J� <br />���,� <br />Lfa NA-F7. ii f}s7L�M QoRS�I 2G6 -3rt3 <br />CONTRACT PRICEOF WORK O- <br />_ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />ygair11AAT1IA1 jcx#Av FGk ate - <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />J4.12 ALAAJ� A'sst L <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LCGALUESCRIPMN+OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STAI-E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTORRN/O��/n AUTHORIZED AGENT DATE <br />x 9/9, <br />PROJECT ADDRESS 0(jl 0— <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />7007 WN c4$t NO FQ-,. <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 />I <br />AIC--AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />MANGE HOOD <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />' <br />I <br />' <br />I <br />SUB TOTAL <br />$ <br />' <br />SUB TOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />' <br />ry <br />FRONT SETBACK <br />REM SE TBACN <br />SIDE SETBACK <br />PI+ANnC�K UMOE{t <br />fEE <br />RECEIPTNO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />FEE <br />BUILDING 37 SOP � <br />�VALUATION <br />1�-w� <br />,,,[Of CONTS. ALLOWABLE <br />TYPE OF CONST. ACIUAI <br />MCUngp <br />NO TO-(L'0-IS <br />' <br />"'" <br />PLUMBING <br />SIZE: OF OLDO. <br />NO. OF SI0RIC5 <br />BASEMENT <br />MECHANICAL <br />' <br />��O <br />_ <br />ADDITIONAL PLAN CHECK <br />p <br />OCCUPANCYLOAD FIRE SPRNKLERS RE00 IIEIGIIT IIMIIALKN+ <br />OTHER <br />i <br />REASONfORSPRINKLERS <br />STATE BUILDING SURCHARGE <br />�$TJ <br />INTAKE DY <br />PLAes <br />va�oveD ur <br />CITY DF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />/(•�/l1 <br />TAX CODE IS 3105 <br />TDTAL <br />S S `j 7✓' <br />