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Ate► <br />J <br />APPLILATION FOR CONSTIivCTION <br />PERMIT <br />IDe Cuergreen <br />CITY OF <br />everett <br />ING DEPARTMENT <br />BUILD <br />259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />T '7 MAIL ADDRESS CITY l41 PHONE <br />MAIL ODRESB <br />CITY <br />ZI <br />PHONE <br />TENANT <br />MAIL ADDRESS <br />C11Y <br />ZIP <br />PHONE SNQ Q iLy.�I,r <br />ARCHITECT OR DESIGNER <br />ctY tiilfy <br />C n n5e DoB2 <br />9ia Huw;� <br />LICENSE• <br />MAIL AD E59 <br />GTY <br />21P <br />PHD'IE <br />GENERALS <br />NiPACTOR <br />1 <br />dle, <br />liS.3'YZG2 I✓ d!i rKxl3?/�r <br />x ni /i <br />�' <br />�N.ali•�l �0 %�n>< /y0/ <br />a2aFr <br />wa lr�2?0 <br />L CENSE <br />MECHANICAL CONTRACTOR <br />MAR. <br />C i <br />Z P <br />PHONE <br />PLUMBINOCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE K <br />CLASSOFWJRN <br />r� _ n _ <br />1"T . m¢RRI IMRRRr I -I <br />RIIILFIND RELOCATION <br />U NEW LJ ADUIUUN Y-k m""'f' <br />FANTACT PERSON AND PHONE NO <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />�DSACRIBEV.VR <br />CONTRACT PRICE OF <br />Gl0 <br />�DO <br />SEOFS I <br />4ROPERw( <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 />iORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPECIFIEDHEREIN OR NOT. THE GRANTING IDEA PERMIT DOES NOT <br />LEGAL SORIPTION BE/L1 OR ATTACH OUR COPIES) <br />}OIr41t3r*0T <br />LDWLII <br />/� <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LOT BLOCK OF /ryTOY <br />l/ /T <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />286.2DO WAG <br />SIONATUFEOFCONTRACTDRO HO IZEDAOENT DATE <br />X r /O ` -a- <br />PROJECTAD DRES <br />APPLICANTS CITY BI'BINESS LICE NO ANDBUSINt33 NAME <br />Ya2;�, 3 <br />s ? � <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/HNDLG UNITS —H.P. <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />BATHTUB <br />BAT <br />UNIT HEATERS—B.T.U. M 00 <br />_ <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />_ <br />KITCHEN SINKS DISP. <br />VENTILATION FAN <br />- <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />— <br />CLOTHES WASHER <br />WOOD STOVE <br />-. <br />METAL FIREPLACES CHIMNEY <br />. <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_- <br />FLOOR DRAIN <br />HEAT PUMP <br />_ — <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />_.. <br />SINK(SERVICE — BAR. ETC.)-- <br />,tA <br />SUBTOTAL <br />s <br />SUBTOTAL S <br />-_ <br />PERMIT <br />P <br />s <br />PERMIT s <br />TOTAL FEE <br />$ <br />TOTAL FEE s <br />FRONT SETBACK REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE PECEIPt NO. <br />USEZONE <br />LOTAREA <br />0YESi SITE <br />FEES <br />VALUATION <br />FEE <br />❑ EB ❑ NO <br />BUILDING <br />TYPE OF COMET, <br />OCCUPANCYOROUP <br />NO OF SWELLING UNITS <br />ALLON'ABLEIACTUAL <br />PLUMBING <br />SIZE OF BLDO <br />No asroRlEs <br />BBMf. <br />OCC LOAD <br />MECHANICAL <br />0Y <br />OTHER <br />ON <br />HEIGHTLIMIIATKIN <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED DYES ONO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICARONACCBY Puss APPR BY <br />Fy <br />1 <br />TOTAL <br />