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ay <br />NO '.V LS <br />9ycn <br />tFs <br />H9 z0 <br />G y <br />O x 0 <br />H3 y CH <br />.z <br />( H C7 <br />Ong <br />0. O <br />zHz <br />H <br />0 C7 to <br />Rp (� <br />H O Vi <br />! 1` <br />APPLICATION. FOR CONSTRUCTI.,oN PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT f4i <br />mP heay. , <br />P <br />CITY Of <br />everett <br />�ORP <br />_ <br />HEATINGSYSTEM: <br />UGAS UELECTRIC <br />❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />COMBINATION <br />BUILDING <br />MECHANICAL PLUMBING <br />SIGN <br />,••NNER <br />MAILADDRESS <br />CITY ZIP <br />FV fi <br />PHONE <br />uJ)m c?- -7 l <br />n1?S <br />I (i� G I%irr�ihiQ <br />a <br />TENANT <br />MAIL ADDRESS 7 <br />CITY ZIP <br />PHONE <br />C4-�CAJ* o99Pc <br />my <br />Q5 We5? <br />y�ILAD9wE S <br />(� yS 60 Or <br />CITY <br />/L� I�c+ry5u/(� <br />PHONE `-3 <br />liti�i lau <br />.FsSGR <br />OCHER CON FACTOR <br />I <br />MAIL ADDRESS <br />CITY ZIP <br />"PHONE LICENSER <br />MECHANICAL ACTOR <br />MAR ADDRESS ,. <br />CITY ZIP <br />PHONE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE VCENSEIF <br />CLASS OF WORK <br />NEW ADDITION <br />ALTERATION REPAIR DEMOLITION <br />_ <br />- WOODSTOVEIFRPL INSERT _. BUILDIMG RELOCATION <br />CONTAC PERSON AND PHONE NO. <br />CONTRACT PRICE[ W K <br />DESCRIBE WORK AND BWARE FOOTAGE MVOLV <br />53 - 5c <br />a is x 331a - <br />f <br />PROPOSED OF BUIIDMG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />#0 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW �FDUR LOw�ey <br />C • f(1 �� <br />LOT .-< )>'30 BLOCK I ✓ J of <br />I ISI b L 1 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />-0 R <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />- I <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />,� +1 <br />THE WHICH <br />KT <br />OPERTY TO PII <br />I y -/ <br />�fClllfidl h VOl1mg I Cll �' `• <br />COMPLY WITERFORM <br />APPLICATIONOWNER ISISRMADE AND H ER STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�! �I A <br />LZF Lh Snohoni�sl, l L%I�1�1"7, �y. <br />SIBGGNNAATTUU/UREEOOFFCCEOONNNTTTR.AACTTORR ORAUTHORIZED AGENT ryDATE q�,�/61 <br />/�lW/' _/"1 — `�^-cl1./'� �%VV /"'7�_-_ <br />i�pIILANTSCITYB AN O BLISINESB NA ME <br />PROJEC/T�ADDRESS <br />�I <br />_ <br />([0��0 /� ��(�J �i�-�' <br />ESSa�S LNO. <br />PLUMBING " <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET( <br />A/C-A/HNDLG UNITS-H.P. <br />Bkl'HTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHESDRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />rrrra=r a r� y R ca �a � I �•e <br />FRONT SETBACK <br />REAR SETBAC4* <br />SIDE SETBACK <br />F <br />PLAN CHECNNUMBER <br />27777 <br />FEE <br />V.loS <br />PEOEIPTNO. <br />-5�3 <br />2 <br />1 <br />2 <br />7 <br />USEZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />g( 'J7) <br />'- I <br />R`z. <br />N 6,6w <br />ti <br />TYPEOF CONTSALLOWABLE <br />TYPE OF CONST. ACTUAL <br />MCJKNCr <br />AppOMwNBIP4TS <br />G 1ppP <br />I <br />PLUMBING <br />I <br />X-ov <br />- I <br />SRE OF BLDG' <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />I <br />5• <br />I <br />go <br />ADDITIONAL PLAN CHECK <br />I <br />i <br />OCCJPANCY LOAD <br />FIRE SPRNKLERS REDD <br />HE IGHT L IMITATION <br />, � R <br />NO <br />OTHER <br />AEAS011 FOR SPRINKLE RS <br />STATE BUILDING SURCHARGE <br />�J <br />INTAKE BY <br />PLANS APPflUVEO BY CITY OF EVERETT <br />PUBLIC WORK$ <br />' <br />LOCAL SALES <br />TOTAL <br />"J P 1e/, I TAX CODE IS 3105 <br />