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APPLICATION FOR CONSTRUCTItoN PERMIT eve"" <br /> the EVeT9PW TO BE COMPLETED IN INK-PLEASE PRINT e <br /> CITU OF _ <br /> everett HEATING SYSTEM: GAS _j ELECTRIC J <br /> BUILDING DEPARTMENT <br /> 259-8010 <br /> DEMOLITION KCOMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> ° R MAIL ADDRESS �7 CITY ( ,vE Sm �j PHONE / / / <br /> raln�x'ibk Str. If. '10.20 /)-P;/l ItLC �f IP A /2(�PHONE (��� 5 Y 'l��Y 4� <br /> TENANT I"k ADDRESS CITY <br /> ARCHITECT OR DESIGNER MAILAODRESS' CITY 21P PHONE F2 2_/?2�V <br /> DDIz/7 £ f�'YIT+lln9 �('irf'Ga+Tp G� I�033 <br /> LICENSES <br /> GENERAL CONTRACTOR MAIL I JE1I RFSS CITY SIP PIgNE <br /> TivnTG� T/TJl s�eifs ly+nTE els owner) 71'u�Ti I D <br /> M MECHANICAL CONTRACTOR MAL ADDRESS CITY 21P PHONE LICENSE <br /> ayy <br /> frj s HONE LICENSE <br /> PLUMBINGCONTRACTGR MAIL ADDRESS CITY 21P P <br /> y f-I <br /> f< n <br /> -3% CRASS O WORN <br /> y y X NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO <br /> zL jam! I T <br /> CONTRACT PRICE O WORN <br /> y - <br /> o 8 E7 DESCRIBE WORN AND SWAM FOOTAGE HNOVED S 7fE ifc 3�3-�{y07 <br /> �y CIinC`1t2r/ new /tiLao (/l�3 s l ) °I� <br /> H Em PROPOSED USE OF BUILDING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Z0. 0 N S/ f 'F.L}IIl l 'A /�PJ I p`l!!C� APPLICATION AND KNOW THE SAME C BE TRUE AND CORRECT.ALL <br /> LEGAL DESCR1110NO PFKIPERIY(SII NBROW OR ATTACHFOUR COPIES( PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> yy y WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> C" H y LOT �� alae« or C LSF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Tn AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> f..I OTHER STATE OR LOCAL LAW REGULATING 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 /> �s•I! APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> H fn CONTRACTORS LAW 10.27 RCW AND 290.200 WAC. <br /> ,a N SIGNATURE OF CONTRACTORORAUTHORISED AGENT DATE <br /> a10 ("alh1-- <br /> PROTECT ADDRESS APPLICANTS CITY BUSINESS LICENSE ND AND BUSNESS NAME <br /> PLUMBINGMECHANICAL <br /> NO. TYPE OF RXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> —WATER CLOSET(TOILET) ' A�A/HNDLG UNITS—H.P. <br /> �_ WA <br /> 1 BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER O' ' CLOTHES DRYERS <br /> KITCHEN SINK A DISP VENTILATION FAN <br /> DISHWASHER �::__— RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> AAAAA AAAA, CLOTHES WASHER WOOD STOVE <br /> _ URINAL <br /> METAL FIREPLACE&CHIMNEY >' O <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP ' <br /> �.. OAS PIPING <br /> BACKFLOW PREVENTERS <br /> ROOF DRAINS—RAINLEADERS EXHAUSTFAN <br /> SINK(SERVICE—BAR.ETC) <br /> A <br /> I <br /> DSUB TOTAL $ f SUB TOTAL f <br /> PERMIT S -+ PERMIT f <br /> - <br /> $ <br /> Tr <br /> TOTAL FEE f (.`"' TOTAL FEE <br /> A FOR OFFICE USE ONLY: FEE RECEIPT <br /> FRONT SETBACK BEAN SETBACK SIDE SETBASK PINK CITE MIMBER <br /> ay ac) s 1� U <br /> USE ZONE lot ANSA VACANT SITE FEES VALUATION FEE <br /> BUILDING <br /> tFPf of CONi6 NlOWABI[ fYRMCONST ACTUAL acawA'T Ao dIKAIInw Mn15 ' <br /> _ PLUMBING <br /> I <br /> HO.OF STORIES BASEMENT MECHANICAL <br /> I s a >, v <br /> - - ADDITIONAL PLAN CHECK <br /> OCCUPANCYLOAD EOD HGH �ITITAIONKR <br /> LIT- �— <br /> _ OTHER I <br /> REASON FOR SPR'NKLERS STATE BUILDING SURCHARGE i Y -O <br /> INTAKE BY PIAHSAPPROVEDBY CITY OF EVERETT PUBLIC WORKS oo I ) <br /> LOCAL SALES p <br /> 9 Nosy TAX CODE IS 3105 TOTAL id ISD <br /> I <br />