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APPLICATiG_J FOR CONSTRUCT . JN PERMIT U <br />E F'c TO BE COMPLETED IN INK —PLEASE PRINT <br />crr OF <br />everett HEATING SYSTEM: GAS ❑ELECTRIC ❑ __ <br />BUILDING DEPARTMENT <br />259.8810 p/ <br />DEMOLITION COMBINATION BUILDING PLMECHANICAL K PLUMBING /SIGN <br />OWNkR '11 4AA Sa0R[S$ M1 ° ^ CI-21-77 �J <br />mn v1L L1111I1i �S.qlAT7� <br />, %,r,,A,�U%A - i <br />ARCMTECT OR DESKIMEP MAE 4'ORE55 <br />!O PIB)NE <br />=A plpjNE LICENSEp <br />f�Velrjr 43E3) �or� <br />zr PMWE LICENSE. <br />c sa RKmK <br />' ALTERATION REPAIR DEMOLITION WOODSTOVE'FRPL INSERT BUILDING RELOCATION <br />NEW ADDITION <br />CONTACT PERSON AND PRONE NO <br />DN K;EaLNO11K <br />— <br />LolDESCR�B(� Wi (�"I I'ARf [001 aBryIXyED ,v'^ y, <br />I/ I I /I <br />P uD [aFB <br />1 HERESY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />1 <br />I� <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TV'PE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEa0. iRIDN O{PROPEANi BELawo"An"cN [au"COp481 <br />10* OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />__ELM._ <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE 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 />CO!ETRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />SKINAIURE C[ COWR/:TOR OR WTNORLEEO AGENT DATE <br />X .�ana 1 dlte 4 q-I i <br />ep [LiCANTSCT BUSmF55 LICENSE NO BNDBVSiNF53 E <br />'RL[CB ADDD-'SS CI <br />V `j <br />PLUMDMIG <br />MECHANICAL. <br />NO. .✓ TYPE OF FIXTURE OR REM <br />FEE <br />NO, <br />T Y PE OF EOUIPMENT <br />FEE <br />WATER CLOSET ITOILE7T <br />AC —A HNDLG UNITS P. <br />FORCED AIR SYSTEMS—B.T U. M EA <br />BATHTUB <br />LAVATORY (WASH BASINI <br />UNITHEATERS—B.TU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCH'_N SINK S DISP <br />VENTILATION FAN <br />'.*HWASHER <br />RANGE HOOD <br />DRY TRAY <br />WATER HEATER <br />RUN <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE S CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF GRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />-- <br />SUBTOTAL II <br />SUBTOTAL 5 <br />PERMIT S <br />PERMIT $ <br />' <br />TOTAL FEE SI <br />TOTAL FEE S <br />rvn vrr... <br />[KOHL SETBACK <br />ALARSETBACK <br />BOESETBACN <br />pUM CwFCA NU4B!p <br />a <br />"ECEipT NO <br />uSI SPrt <br />LOT AREA <br />VACANT BRE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />nn DF CONTS ALLDNLRE <br />rof a MEET ACTUAL <br />IXfiD[LL+ ViB PLIULRwM1 <br />' a0 <br />— _ <br />PLUMBING <br />—_— <br />Sig OF SAW NO OF STDALES BASEMENT <br />OCCUPANCY LOAD FwE SPANKLERS Rf6D NEgBTLPNTATx}L <br />RfAsoN[aRspnmKU:Rs <br />MECHANICAL <br />—L� L: cK, <br />ADDITIONALPUN CHELK <br />— <br />OTHER <br />— <br />STATE BUILDING SURCHARGE <br />muKE BY <br />MNS APPNOVEO by <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX GOOF IS 3105 <br />PUBLIC WOIIKB <br />TOTAL <br />— <br />eo <br />