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APPLICAT10h . FOR CONSTRUCTI.eN PERMIT PI( <br /> ,hA ElwNgwn 10 BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS UELECTRIC U _ <br /> 259-8810 <br /> I DEMOLITION KI COMBINATION 111 BUILDING I I MECHANICAL LI PLUMBING IJ SIGN <br /> n MAAADDRESS CITU ZIP PHONE <br /> TENANT MAIL ADDRESS CRY Zip 7 /PHONE <br /> ' ARCHIIECT OR DESIGNER MALADDRFSS. C11Y ZIP IKONNE <br /> L, 22 - /721/ <br /> GENERALCd/1RACTOI MAILADDRESS CITY ZIP Pi"E LICENSE& <br /> 7�'t'ntt'II k .T' OL's•I/'Ir <br /> MECHANICALCONTRACIOR MAX AWRESS CIM ZIP PHONE IOENOEI <br /> PLLMBMO CONTRACTOR MAL ADDRESS CITY ZIP PIIDNE LICENSE/ <br /> CUSS OF WORK <br /> I NEW I_I ADDITION LI ALTERATION I I REPAIR LI DEMOLITION I I WOODSTOVE/FRPL INSERT I_] BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO j <br /> CONTRACT PRICE OF WORK 1 .} �(?7 LL <br /> DE'C�MSE W.OAK AND SOUARE FOOTAGE INVOLVED i.i., <br /> PROPOSED USE OBULDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S,11 /r 1.`111)(�r. !"(' fl`r IF c'. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL <br /> DEV <br /> E RIPTION OF PROPERTY SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOT 5e' BLOCK DF /�al YI l/j['l /�ly:f1' WORK WILL EE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMI' DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CAI TEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGU ATING CONSTRUCTION OR THE <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 10.27 RCW AND 296.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> PLIO.IECT ADDRESS Ft aw— <br /> �_�.,� APPLICANTSCHY DUSINESSLK;ENSE NO ANDBUSINESS NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> _ WATER CLOSET(TOILET) / I A/C—ArHNDLG UNITS—H.P <br /> BATHTUB _ ' FORCED AIR SYSTEMS—B.T.U. M E.A. _- — <br /> �' LAVATORY(WASH BASIN) 1 UNIT HEATERS—B.T.U. M ) <br /> / SHOWERr_ !F' CLOTHES DRYERS i— <br /> / KITCHEN SINK 8 DISP 4_1 VENTILATION FAN I <br /> DISHWASHER I RANGE HOOD , <br /> LAUNDRY TRAY I WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE , <br /> URINAL ' METAL FIREP CE&CHIMNEY 3rd: <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN I ' <br /> HEAT PUMP <br /> BACKFLOW PREVENTERS 'A _ K GAS PIPING 1 <br /> T <br /> ROOF DRAINS—RAINLEADERS I EXHAUST FAN , <br /> SINK(SERVICE—BAR.ETC.) <br /> I I <br /> I <br /> _ 1 <br /> I - <br /> I I <br /> 1 <br /> SUB TOTAL S ; _ SUB TOTAL $ V' — <br /> PERMIT $ I PERMIT f , <br /> TOTAL FEE S .'S' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> TOTH SETBACK REARSETBf SIDE SEInM:K/ PLAN� CHECK-.NMBER FE RECEIPT NO.� �.3 .3 <br /> USE ZONE LOT AREA VACANTSHE FEES VALUATION FEE <br /> 194 BUIPOING -29Y <br /> TYR IX CDNTS ALLOWABLT TYPE d CONST ACIUM OLpIM.h 0MUM6 DnR <br /> -3 P.UMOINO !!- <br /> SUEqq((BLDG NO.OF STORIES BASEMENT -Y7 , <br /> -7/ MECHANICAL <br /> OCCUPANCYLOAD FIRE SPRINKLERS REOD NEI!'lll Ll ITATK)N ADDITIONAL PUN CHECK — <br /> nE�srxN Fon srnmM.Ens OTHER _ <br /> STATE BUILDING SURCHARGE 10 <br /> NUKE BY PUNS APPI1OVFn BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES aU ' o"v <br /> 7 I,/y TAX CODE IS 3105 TOTAL / <br /> I <br />