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APPLICATION FOR CONSTRUCT& PERMIT <br />Tn Rc rnupi P=n IN INM—PLEASE PRINT <br />,v —• <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />HEATING SYSTEM: U GAS N ELECTRIC U _ <br />DEMOLITION <br />: COMBINATION <br />BUILDING <br />MECHANICAL <br />L PLUMBING I SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />LIP <br />PHIXIE <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR CESIGNM <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />n (A)A <br />iENERAL CON" <br />MAIL ADOflf55 <br />CITY <br />ZIP <br />1.1CNE <br />LICENSE• <br />/7 ulfl <br />LN a r <br />PlICTOOR <br />MECHANICAL LO•�Rl <br />MAM1dDORESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />� <br />PLUMBINGCONIR..ACCT^TORyy <br />MARADDRESS <br />CRY <br />ZIP <br />PHONE <br />LICENSES <br />CLASS OF WURH <br />MFw At AnnITICYN <br />1 AITFRATION <br />REPAIR DEMOLITION <br />WOODSTOVHFRPL INSERT BUILDING RELOCATION <br />— <br />CONTRACT PNICE11i KCnN <br />CONTACT PERSON AND PHONE NO. AE �I <br />fJ /AEI �u �oAAiA ���� `�y / 1}i r+�� <br />DESCRIBE WOPK ANDSWAgE frO�OtAGE INV0.V1ED 11 <br />/ ] % <br />PIIOPoseD EOF Iam'lOwe <br />%o}ir�?' DUPL F-X <br />I 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 />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 09 THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B: 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 296210 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X00 <br />LEGALUECRIPTKMOFPWPEnTYISH OELOWon AnALNFDURCOP,Es1 <br />LOT__ BLOCK OF _ <br />Sin^ 4p A 1 <br />h <br />PPOJELi AD0RC55 1 <br />t /- <br />APPLICANT CITY BUSINESS LICENSE NL AND BUSME AME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />I TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET)I <br />ACC—AIHNDLG UNITS—H.P. <br />BATHTUB <br />i7 <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_L <br />LAVATORY (WASH BASINS <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITC1, SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />/ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE X CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <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 />TOTAL FEE $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />HEAR SETBACK <br />2 o <br />20 <br />USE ZONE <br />LOT AREA <br />TYPE OF <br />COGS ALLBWABLE <br />TYPEWIANSTACI <br />�.OFS^IWIfS <br />Ia,4 SFD4CDN-i- <br />.;, G S€7 1 a.9 f. 7.f <br />BUILDING <br />oc r wwonuuNcuuns <br />PLUMBING <br />BASEMEN} MECHANICAL <br />_k1/A N.1 <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />MUKE By <br />-" <br />PLANS APPPOVFOBr <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />- <br />