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APPLICATIO6, FOR CONSTRUCTLoN PERMIT i <br /> rhe EYe,gw" TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT HEATING SYSTEM: GASS U ELECTRIC U <br /> 598810 <br /> �'� DEMOLITION COMBINATION )(BUILDING MECHANICAL PLUMBING SIGN ' <br /> OWN R MAR ADDRESS CITY ZIP PHONE <br /> I uI�bl�ok ,( f y62L /��,�, s�&-nc r,,11 gf202 (Y61) <br /> TENANT MAR ADDRESS CITY ZIP PIKINE <br /> ARCHITECT OR DESIGNER MARADDRESS CITY ZIP PHONE <br /> C�]AH bf):r Clr<./1 4, Iplofl111T�e 1l�l�l'G`i,10 GA c1,?2IL - <br /> [''G GENERAL CONTRACTOR MAR ADDRESS CRY ZIP PHONE LICENSE• <br /> Clay 7r_- Im4#_le 7; Ie(uS 7x rb.,riyfnY,4+4de,r ) -7—Pu If/) <br /> A <br /> H MECNAMCALCONTPACTOA MAILADDRESS CITY ZIP PHONE LICENSE <br /> a y En <br /> HPLUMBMGCONTRACTOR MAIL ADDRESS CITY ZIP PIKNIE LICENSE <br /> y H <br /> F4 C] <br /> y�l cuss of vroRlc <br /> NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> V1�C.HNF..H.�I CJNTACT PERSON AND PHONE NO <br /> z d CONTRACT PRICE OF WORK <br /> Pl IF`H7JL[[��11 DESCRIBE WOU <br /> WORK AND SARE FOOTAGE BNO-VED <br /> L7nillUL /aw he se /ISG: -Ira ItLcl) <br /> H [m PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> H• �Onq±± S/e 1C IC �.g11111 1 C) APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Z H t� LEGAL DESCRIPTION D<PROPER IENOWNBF.LOW OR ATTACH FOUR GOPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> •�' L.oTIII BLOCK OF I1/,1 6lteK WORK OFIED HEREIN OR <br /> T. THEWILL <br /> GRANTING OFA PERMIT DO ESNOTPRIES ME TO GIVE <br /> �yHyAUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> p N H OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> n t7 N PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> �v OWNER OF I PROPERTY PERFORM WHICH <br /> ltn APPLICATIONIS MADE A DIKR <br /> COMPLY WITH THE STATE <br /> H y0 co CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> PROAiCTADDRESS <br /> 6014, <br /> a APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE Of FOUIPMENT FEE <br /> 3 WATER CLOSET(TOILET) aC—NHNDLG UNITS—H.P. <br /> I BATHTUB '.$ FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> '3 LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> / KITCHEN SINK 6 DISP r VENTILATION FAN <br /> _ DISHWASH[R / RANGE HOOD <br /> LAUNDRY TFVY WATER HEATER <br /> CLOTHES WASHER _ WOOD STOVE <br /> �. — <br /> URINAL METAL FIREPLACE 6 CHIMNEY �U' <br /> DRINKING FOUNTAIN FIREPLACE INSERT_ <br /> + FLOOR DRAIN s— HEAT PUMP <br /> BACKFLOW PREVENTERSGAS PIPING <br /> ROOF DRAINS—RAINLEADERS r EXHAUST FAN <br /> _ SINK(SERVICE—BAR,ETC.) ' n /-24w. " 0'-) <br /> SUB TOTAL f SUB TOTAL f O ' J 7 <br /> PERMIT f —r PERMIT f - <br /> TOTAL FEE f TOTAL FEE f ' J' <br /> FOR OFFICE USE ONLY: <br /> rROTIT SETBACK HEAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE 64 RECEIPT NO <br /> 261 Zae F o. 27 <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> BUILDING <br /> IYPE or coxrs uUYNASU IM or CONST ACTuu <br /> oLLIF«r. ro a OMl,iW UNo, --PfFI <br /> "eJF PLUMBING <br /> SIZE OF 8100 NO OF STORIES BASEMENT MECHANICAL ,/' <br /> /R I <br /> OCLIIPANCYLOAD FIRE SPHNKLERSREOD NEIOWLIMT;7 ADDITIONAL PLAN CHECK I <br /> NA u 2$' <br /> OTHER � <br /> REASON FOR SPRINKLERS , <br /> STATE BUILDING SURCHARGE <br /> bOAKE eY <br /> PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> I% TAX CODE IS 3105 TOTAL j,4J <br />