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APPLICATION FOR CONSTRUCT AER <br />��((�((��%alp <br />t ett <br />uull!! <br />FEB�9 <br />mor Eoro1PNi TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF .__.. <br />everett HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑ <br />_........... ...F...EVERE <br />petln <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING )<MECHANICAL <br />PLUMBING ; SIGN <br />fINMCR MAl ABUREES CITY ZIP PHONE <br />Mnek[-21Ms ENt�lGtscS 6/s -//z" SY• 5.4 .cv. LV�'• <br />98sa1 3 ;3ALU <br />TENANT MAILADOP.ESS cm VP PHONE <br />.,K - ys S e <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY LP PHONE <br />GEN4RAl CONTRACTOR MAB ADORERS CT' ZW PHONE DCENSE.KAt�� X%/O/✓� <br />A,ai./rs fL�,if�.£C lsn.T� i .P.., Lr�.e 6u. vn. 9yi,.i 7kY/&Z1 <br />PLUMBPIGCOYIRAC1d1 MARADDRESS CT' ZIP PHONE LICENSE. <br />CLASSd WORK <br />f I NEW ❑ ADDITION O ALTERATION REPAIR I 1 DEMOLITION F1 WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />t <br />2dRMGT PRICE OE WCBN p ✓ <br />LI PER <br />CONIASO AD PHONE <br />NON <br />DESCRIBE WORK AND UVARE iCOTAGE MCLWD <br />�Ge ,.,..ac. c <br />PROPOSED USE OF BULUPNG <br />, fg-f fA,.,(• i <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO 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 OR T14E <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 13.27 RCW AND 295 200 WAC. <br />SIGNATURE OF CONTNTRRRAA-FCCTTOOR OR AUTHORIZED AGENT DATE <br />A <br />LEGAL DESCRIPTION OF"ROPERTY ISINMI BELOW OR ATTACH FOUR COPIES. <br />LDT VOCK OF <br />gROIECi A0011E55 <br />x /7 /11 /M �r F`� <br />L <br />_ g&dap <br />APPLICANTS CT' BUSME GENSC NO. AND BUSMSS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />ri PE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AC--A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M i <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOF_ <br />_ <br />LAUNDRY TRAY <br />WATERHEATER p pcp,Q/y <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />i <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />O <br />PERMIT $ <br />PERMIT $ <br />/1 <br />TOTAL FEE $ <br />TOTAL FEE S <br />1 <br />FOR OFFICE USE ONLY: rA ]G EG2 J1 <br />FRONT SETBACK <br />REAR SETB.ICK <br />SIBS SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />PECEIPTN0 <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE IN CDINS. AUMME <br />nxacoxn M:TWI <br />aa.FM, aacwulwlvns <br />SIZE OF BLOO, <br />NO. OF STMIES <br />SABEMEW <br />MECHANICAL <br />i— <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REOD HEGNT OMRAIGN <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />MAKE BY <br />PLANSAPPROYEDBY <br />(.J <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />