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APPLICATION FOR CONSTRUCTI..N PERMIT evefe1 <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />eEYBTgT"R <br />CITY OF <br />eve rett I HEATING SYSTEM: U GAS U ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION IN COMBINATION BUILDING I I MECHANICAL I PLUMBING SIGN <br />OWNER MAIL A------ CITY LIP PHONE <br />EdIT{I gd�rn 11C) - -) e Jf. tL'ra/-,rr ldA`r <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />AHLIIITECT OR pESIGIJER MAIL ADDRESS CITY 21P PHONE <br />C vf!o <br />GENERAL CONTRACTOR MAIL ADDRESS CITY 21P PHONE LICENSER <br />fVML_GSA11•/r (of 3T 113 i //L,( 1)1 r rrLc cI;t/=Hfr '7 SI r Lit-)aSG v,�L/j.vc t/ 23�L✓y <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 21P PHONE LICENSE <br />dA✓% djKd .g > I CC f /!� GFJ/'/: f`li/ ' ' ) Z 2L/'1L/IU CLASS OF WORK I I nL„n11T.nM I I WnnnATOVFIFRPL INSERT I I BUILDING RELOCATION <br />I I NEW I I AUUII IUN I ML ICnnnvn <br />v+ ........ <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK <br />SQUARE FOOTAGE INVOLVED <br />DESCRIBE WORK AND <br />dTnrRrhoott FG�a)R�N R'�rii <br />t`Lt'`__ S <br />PROPOSED LSE OF BUILDING ` <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 />LEGAAL`DME-SORi,LOF /P'RgyEL TY 6yIJWN RELO\VOB ATTACH FOUR COPIE51 <br />LOT 10 BLOCK Vf OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />T N I C.f GL yU 19p.0 <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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />x <br />APRR)CARTS CITY BUSINESS LICENSE NO AND DHSINESS NAMt n, <br />PROJECT ADDRESS <br />110 L, 1 FI` V )7. <br />L. <br />PLUMBING <br />FEE <br />MECHANICAL <br />TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />I WATER CLOSET (TOILET)A/C—A <br />HNDLG UNITS—HR.. <br />FORCED AIR SYSTEMS—B.T.U. M E.A.LAVATORY <br />I BATHTUB <br />UNIT HEATERS—B.T.U. MSHOWERCLOTHES <br />(WASH BASIN) <br />I <br />[NO. <br />DRYERS <br />KITCHEN SINK 8 DISP <br />i_VENTILATION <br />FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />__ <br />WOOD STOVE <br />' <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />i <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />- <br />BACKFLOW PREVENTERS <br />' <br />' <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />! <br />1 <br />EXHAUST FAN <br />h ' <br />SINK (SERVICE —BAR. ETC.)— <br />I <br />I <br />SUB TOTAL <br />$ <br />I <br />�_ <br />SUBTOTAL $PERMIT <br />I <br />— <br />PERMIT <br />$ <br />$ <br />----'- <br />- <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK <br />USEZONE LOT AREA <br />TYPE OF CONE. ALLOWABLE TYPE Of CONST Al <br />SIZE OF BLOC NO. Of STORIEI <br />LNCYLOAD <br />J FOR SPAINKLERS <br />eY <br />VACANT SITE <br />ttLD <br />BUILDING <br />IKLIIn y <br />GBMIP <br />w9PAulw IKRs <br />PLUMBING <br />BASEMENT <br />IIEg11i I IMITATION <br />MECHANICAL <br />ADDITIONAL PLAN CIIGCK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />FCE <br />m <br />1fl <br />i <br />