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.,...� r�. Ga s �(4�T <br /> APPLICATIOI�1 FOR CONSTRUCTI6N PERMIT <br /> everett <br /> the Erergrcen � <br /> GTV OF <br /> everett <br /> BUILDING DEPARTMENT <br /> 259•8810 TO BE COMPLETED IN INK—PLEtiSE PRINT <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNEN MAILAD�(1ESS CITY 21P FMUNE <br /> (,Joo��/�a U�e�� f/o��s � O, ao,�' lC3,2 ���n� wvor/ !tih . 9go94 5`/�� 3 96 9 <br /> TEN�NT MFIL pDDRESS CITY 21P PNONE <br /> ARLHITECTOROESIGNGfl MAILADDRESS GITV ZIP PHONE <br /> GENERALCCNiRRC10R MFILqODRESS CITY ZIP PMONE 'ICENSEt <br /> GJpocllia Ven Nomes � Q. QoK 1�.3� ,�vnnc000c� ��v. �Sa%C• ��:� -39Gq �.l�oE��i'17ye$' <br /> MEG�ANICALCON"PALiOP MPILADDRE55 CITY ZIP PHOtiE UCENSE� <br /> PLUMBINGCON'FFCTOP MAILADORE55 GITY 21P PHONC LIGENSEI <br /> fLASSOF WORK <br /> �NEW . . ADDITION �. �� ALTERATION � . REPAIR . DEMOLITION . WOODS70VEiFRPL INSERT -. ' BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOii REIdO�EL ONLV CONTACT PERSON ANO PMON��E/NO. /� / � <br /> CONTRACT PRIGE OF WOFK: 7 Q OO O C ��G/^�I lLG��/J�r �i <br /> OESCRIBE WJRK P40 SOUARE FOJTAGE INVOLV D , <br /> Ne w .s�F ,k S O 5y� - 3 9 � 9 I <br /> PROPOSEDUSEOF iLDINGy� I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br /> `S� �'1 I � I-A/t�l l I APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> l[GRL�ESCRIP IONOF PBOPERTY(SHO1'N DElOW J��iTACH FOl1ACOPIE�I51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> �f�I eWOoq �e1�YqC WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT� BIOCK oF _� NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE O'i LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PERFOAMANCE OF(:ONSTRUCTION.THAT I AM AUTHORI2ED DY THE <br /> OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGNRTUPEO`CCNTRACTORORFl1iHORIZEDAGENT D4TE <br /> PR0.IECTAD�D}RE55q � �„�- � //" /�D <br /> GJ J � /�� vSC' APOLiCANTSCITYBU5MES5LICEN5EN0 DBOSMESSNAME I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> 3 WAT[R CLOSET(TOILET) A'C—AiHNDLG UNITS—H.P. <br /> FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � BATHTUB _ . I <br /> j LAVATOFV(WASH BASIN) UNIT HEATC:RS—B.T.U. M <br /> ,j, SHOWER � CLOTHES DRYERS ' <br /> ( KITCHEN SINK 8 DISP tj VENTILATION FAN ; <br /> 1 DISHWASHER � RANGE NOOD <br /> LAUNDRY TRAY � W.1TER HEATER ' <br /> CLOTHES WASHER WOODSTOVF <br /> URINAL METAL FlREPLACE 8 CHIMNEV <br /> DFiINKING FOUNTAIN FIREPLACe INSERT <br /> FLOOR DRAIN HEAT PUMP �I <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHhUST FAN � , <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � G�,.�iZ._ z�-�:r L� <br /> T I <br /> 1 <br /> SUB TOTAL S O SUB TOTAL $ (n .• ' <br /> PERMIT S P[RMIT 5 i <br /> TOTAL FEE S TOTAL FEE $ G� '� , <br /> FRONTSETDACK REAFSET�ACK S�D[SETBA�N / Pl4NC9[CNNUMBER FEE RECEIPiNQ � <br /> � �1'O � �l �� . <br /> usezo iorn�aen vncnNrsrte FEES VALUATION FEE , <br /> ��� /O�p /ves No BUILDING �_ � s��� ; sa <br /> lYFEOFCONSi.ALIOWABIE 1YPEOfLON51ACiUdI a4uraqcr xn��mvEw�cvniR �— <br /> raou^ p�UMBING � � � � <br /> %f� .,r/ �.3 / lo <br /> St2EC'BLDG. NO.OFSTORIES OASEM[NT /C � i '� <br /> MECHANICAL �j <br /> /�Yff/' Y�-V .1- . �. YES /NO — I <br /> OCCUPANCVLOAG FIRESPRNKLERSREO'D NEIGIITLIMITrITION OTHER I <br /> �/��/- �. '� VES :�10 � <br /> STATE BUILDING SURCHARGE �,fTl I <br /> REASON FOR SPRINNLERS <br /> STATE ENERGV SURCl1ARGE <br /> i <br /> APPLICATIONPCG.�V PL�NSAPPROVCDBY CITYOFEVERETT PUBLICWORKS �O i� <br /> �� LOCALSALES <br /> c;�ii TAX COOE IS 3105 70TAL 7 �vs <br />