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A <br /> APPLICAi'ION FOR CONSTRV.:TION <br /> PERMIT <br /> Pm E...Pr <br /> Cf <br /> everett <br /> BUILDING DEPARTMENT rleCY <br /> 289.8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> OWNER r MAIL AUUNLSS G.TY PRUNE <br /> E-A"1 ✓VIl.0otjL677 972(- I �6STSC L-✓E2r([ 9fszo 337- �F53.. <br /> TENAN, MAILAODRESS CITY tiF' PHCRIL <br /> ARCHITECT OR DESIGNER MAILADDRESS G'Y IIP PHONE <br /> GENERAL CONTRACTOR MAR ADDRESS Giv IIP PHONE LICENSE <br /> c�H Da�,✓�2 GAl / <br /> MECHANICAL GONYPACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE• <br /> ayti <br /> H ,; PLUMBING CONTRACTOR MAIL ADDRESS CITY TIP PHONE IiF.TNSC <br /> j GL H <br /> H3.O CLASS Of VRA. <br /> 0 =H <br /> ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPL INSERT 0 BUILDING RELOCATION <br /> TENANT IMPROIEMENT OR INTERIOR REMODEL ONLY LONIAOT PERSON AND PHONE NO <br /> H CONTRACT PRICE OF WORK t, , s�.ya C 2L L.PC2s 3 / <br /> 37-75-3 <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br /> 08 -5LLQ c /--/g f cY /Q 60 0 <br /> H tE7 PPGPOSE EOF BUILDING �" I HEREBY CERTIFY THAT I HAVE READ AHD EXAMINED THIS APPLICATION AND <br /> a KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AND <br /> zy LEGAL DESCRIPTION OFPROPERIYISHOWNBELOWOR ATTACH FOUR COREY ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> .�HL•'T' SP 33- 9a WHETHER SPECIFIEDHEREIN OR NOT.THE GRANTING OFAPERMIT DOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> I.N I.OlegW BLOCK/ OF ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br /> U V1 FORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE OWNER OF <br /> o H J�- THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br /> 0 CTA AND I COMPLY WITH THE STATE CONTRACTORS LAW 1877 RCW AND <br /> 286.400 WAC <br /> SIGNATURE DF CONTRACTOP ON AUTPO RIZEG AGENT DATE <br /> [o _ /� y <br /> y o vl _ X C u-L�7. MIN (LF e — <br /> �e�- s3 sr sc <br /> PROIECiAWPE48 APPL N;ANTS GTY BUSINFS9lICEO BUSME89 NAME <br /> r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET ITOILETI _ / S - NC_-AHNDLGUNITS-HP <br /> BATHTUB 1y FORCED AIR SYSTEMS--BTU. MEA <br /> LAVATORY(WASH BASIN) L(_-- UNIT HEATERS-BTU -M—__- <br /> 'L SHOWER /C•' / CLOTHES DRYERS <br /> KITCHEN SINK A DIS_P _(' - J� VENTILATION FAN — <br /> DISHWASHER _ - _ _s J RANGE HOOD <br /> LAUNDRY TRAY / WATER HEATER <br /> / CLOTHES WASHER J- 19001)STOVE--PE//Tr-r _ U <br /> URINAL SIE TAL FIREPLACE A CHIMNEY _ <br /> ATS DRINKING FOUNTAIN I)REPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> _ BACKFLOW PREVEN FERS GAS-PIPING <br /> I ROOF DRAINS-RAINLEADERS - LKHAUST FAN_ <br /> SINK(SERVICE-BAR.ETC I _ <br /> Ll ' _ -_ -__ SUBTOTAL _ 5 1 _ SUBTOTAL _$ <br /> _ PERMIT5 PERMIT _ $ <br /> TOTAL FEE 5 1--- 93, - - -- TOTAL FEE S —A/ _--- <br /> WONT 51TNAL! ( HAPUE•DACK '..UE SETBM,I( FLAN CHECK NUMBER FEE (W RECEIPT NO. <br /> ' 20 20 ' y" 3cuvo )P899r . -7PPY <br /> USE ZONE-- LOT AREAverµTBRE FEES VALUATION FEE <br /> ac [e nNO / p 'I y <br /> TYPE OF NST OCWPANCYG,IOUP NO OF DWELLING UNITS BUILDING y87T� 3�DO 00 <br /> ALLOWA EIACTU <br /> R- _ // PLUMBING 00 <br /> SIZE Of BLOC 1 NO OFSTORR9 BNMT OCCLOAD <br /> SZ�� U N MECHANICAL <br /> "EIGHT OTHER�L/! /P�e-.G sSl /O <br /> A <br /> FIRE SPRINKLERS REWIREDRE SPRINKLERS REWIRED OYES)(NO STATE BUILDING SURCHARGE ,rL <br /> STATE ENERGY SURCHARGE <br /> APPLICATIGN ALL BY PANS PANS APNI RY� <br /> PUBLIC WORKS �O e0 <br /> � /W <br /> TOTAL O,/ <br /> V �, <br />