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APPLICA*m'ION FAR CONSTRUCTION <br />PERMIT <br />Me Ewrpleen everett <br />CITY OF e <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />OWNER MAILADDRESS CITY ZIP PHONE <br />)I-NtaliiVYl li Y3EIOgl N/iiAlVE CVFWFr (,A�TeoS 259 l75s <br />TENANT MAILADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL .OGRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />LICENSE. <br />Y- (DwNFrz <br />MECHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY 21P PHONE <br />LICENSE. <br />u <br />G <br />i-4 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 21P PHONE LICENSE <br />m m I --I ❑ ocoelR Fl nFMO11TION ❑ WOODSTO'/E/FPPLINSERT ❑ BUILDING RELOCATION <br />— W.z.. .J ............. — .._. _......_._ <br />TENANT IMPROVEMENT OR INTERIOR ;_MODEL ONLY <br />CONTRACT PRICE OF VIORK <br />CONTACT PERSON .ND P IONE NO. <br />DESCRIBE WORK ANOSOUARE FOOTAGE INVOLVED <br />/NSTA LL wof)® PEul F Sro v E <br />PROPOSED USE OF BUILDING <br />PRI4r)re RESIof E <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 />ORDINANCESIGTHIS TYPE H WORK WILL BE COMPLETED WITH <br />WHETHER SPECCIFIEEDDHEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOL ATE OR CANCEL THE PROVISIONS OF <br />ANY OTHERSTATE ORLOCAL AWREGULATING CONSTRUCTION ORTHE 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 />296.200 WAC. <br />SIGNATURE OF CO ACTOR OR AUTH RIZEDA HT DATE <br />X U%I P3 M F � � �. ��' - is-_ <br />LEGAL DESCRIPTION OPENTYISHOWN BELOW OR ATTACH FOUR COPIESI <br />OP PR <br />LO7 BLOCK OF <br />PROJECTADDRESS - <br />/605- viP jfmlA AVE- rVFRE7t ,kA FSZ05 <br />APPLICANTS CITY BUSINESS LICENSE NO AND BURIN BB NAME <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/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />1W41THEATERS-BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISK <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING _ <br />ROOF DRAINS - RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE - BAR, ETC.) <br />SUBTOTAL 8 <br />SUBTOTAL 8 <br />PERMIT S <br />PERMIT $ <br />TOTAL FEE & <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SACK <br />SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />❑ YES VACANTSOENO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TVPEOF CUNST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYOROUP <br />NO.OF DWELLING UNITS <br />PLUMBING <br />-- <br />_ <br />SIZE OF BLDG. <br />NO —STORIES <br />BSMT. <br />OY <br />ON <br />OLC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYES ❑ NO <br />HEIGHT LIMITATION <br />I STATE BUILDING SURCHARGE <br />_ <br />APPLICATION ACC. BY PLANS APPR. BY <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />i <br />Im <br />