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APPLICATIOM.F FOR CONSTRIlMiN PERMIT everett <br /> rnPERll,r• TO BE COMPLETED IN INK--PLEASE PRINT <br /> CITY OF <br /> everett - -- <br /> BUILDING DEPARTMENT HEATING SYSTEM: j Q S U ELECTRIC _J <br /> 159.8810 <br /> DEMOLITION COMBINATION KBUILDING MECHANICAL PLUMBING SIGN <br /> OYMER MAK ADDRESS CITY ZIP PHONE <br /> / irien '),r -5 T y. t. /t11C /Tnr.) _''vrolw 6..9 r1 !ltal (.:=ll/) _<. <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS. CITY ZIP PHONE <br /> DD_T Qrz./I £ PN,,,o)ml k( r' t74ilD �L'9 Y22 -17? <br /> L'J � GENERAL CONTRACTOR MA LAMKIESS CITY ZIP PHONE LICENSER <br /> fyj iy]y T'vi-t Or r ,Tt 0 i5 J-4'c l"le tic cu )fA: I <br /> MECHANICAL CONTRACTOR M'•AADDRESS CITY ZIP PHONE LICENSER <br /> G H <br /> a 5H fA <br /> H 9MAIL ADDRESS CITY zip PHONE LICENSER <br /> 3 PLUMBING CONTRACTOR <br /> .0 y CLASS OF WORK <br /> 0 H 0 1C NEW . ADDITION ALTERATION - REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO 'I� <br /> zl3 ;ONTRACT PRICE OF WORK �Z7 J •1 353- -Y YO <br /> CE7 O LT�1 DESCRIBE WORK AND SQUARE FOOTAGE NVOLVED <br /> G H � ne4J h()<•I,SA?. -I _ <br /> H08 <br /> ttrj PROp,OSED USE OF SU0.l!0W� O I �IEREBY ,,^.ERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> d ..Si r1 �� 9Til+NCB rCS I Ct'/TCG. APPLICATIONAAD KNOW THE SAME TO BE TRUF AND CORRECT.ALL <br /> H PROVISIONS CF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> az H lEOAL DESCRIPTION OF PROPERTY) SELOW^.�R"ATTACHFOUR COPff SI <br /> t" H y to sy BLOCK OF <br /> lKiFY IXCX)K /y * WORK WILL B c 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 /> CAH OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 0 ow - - - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> m tH OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> m APPLICATION IS yN CONTRACTORS LAW 1E627RCW AND 298.200 WAADE AND I COMPLY C, THE STATE <br /> Oy SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> QPROJECT ADDRESS <br /> • i,/ APPLCANISCITYBUSMFSSIICENSENO ANDBUSINESSNAME <br /> PLUMBING (r L'L MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET( I A/C-A'HNDLG UNITS-H.P. <br /> '�►' r' ' FORCED AIR SYSTEMS-B.TU. M E.A. ' <br /> 1 BATHTUB <br /> LAVATORY(WASH BASIN) - UNIT HEATERS-B.T_U. M r— <br /> � .� SHOWER i"' CLOTHES DRYERS ' <br /> 1 KITCHEN SINK 8 OISP VENTILATION FAN <br /> DISHWASHER _ i RANGE M000 ' <br /> LAUNDRY TRAY WATER HEATER <br /> r CLOTHES WASHER •��_ _ WOOD STOVE <br /> URINAL METAL FIREPLACE d CHIMNEY ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEAOERC _ EXHAUSTFAN ' <br /> SINK(SERVICE-BAR.ETC.) _ _ F 1wob w <br /> ' — <br /> .� I <br /> I <br /> I <br /> SUBTOTAL S ' SUBTOTAL $ 90 ' <br /> _ PERMIT S PERMIT $ <br /> TOTAL FEE S TOTAL FEE $ d ' <br /> FOR OFFICE USE ONLY: <br /> nr_4m CTBAGr REAR SETBACK SIrE SETBACK RAN CHECK NUMBER FEE RECEIPT NO <br /> L0 20' e A to' 30°¢ 134Z-3 <br /> USE ZONE LDTAREA VACANT SITE R FEEC VALUATION FEE <br /> _' BUILDING <br /> TYPE OF CdRli MlON'ABIF IYHa SI ACTUAL IawMr. AB MIwIH�ACIAnre PLUMBING , R <br /> SIZE OF IKDD NO OF STORIES BASEMENT MECHANICAL go; J <br /> /fzl f- yT/a3• 0A -r7 O <br /> OCCUPANCY LOAD FIRE SPRNKLERS REDO HEIOHIUMITATION ADDITIONAL PLAN CHECK <br /> N R• 71 (� J 0 E - <br /> OTHER <br /> REASONFORSPRINKLER9 F <br /> STATE BUILDING SURCHARGE (� <br /> INTAKE BY RUNS APPROVEDBV CIIY OF EVERETT PUBLIC WORKS ;122 <br /> ^� LOCAL SALES <br /> TA%CODE IS 3105 TOTAL 2/ • ; irk <br />