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APPLICATION FOR CONSTRUCT., JN PERMIT E" <br /> fNPegP TO DE COMPLETED IN INK—PLEASE PRINT <br /> CR Y Of <br /> eve ret tHEATING SYSTEM }I GAS J ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259.8810 F <br /> DEMOLITION COMBINATION )C BUILDING MECHANICAL PLUMBING SIGN <br /> OWN A</A QQ /�{ALL AVORE59' -7' I GITY IP L PHONE,- 1q :j l.%,,':/ , • ! <br /> '�--Y .ApI�Vyr'r!✓! 111:/ li�I�cf. C�J((,.r,•/tr,<r ��/C(. `;'Wey"' Jr -//�/�J <br /> TENANT [�Qa7�� /"� Lf�fJ • U'TY IIP PHONE <br /> AR i T pEEBN[R MIK AGGRESS .f y�.,� NO /` <br /> Y T d /" GC'I-(' y q•9' ; <br /> CITY <br /> LII 21`��•; Ti ` PHONE iT•Y'�-���� <br /> r ,l rC <br /> GENERALCONT AtDRE b A ' PHONE LK:ENSEI <br /> -T/jy r ,,, 1449.us <br /> MECHANICAL CONTRACTOR MAIL ADDRESS <br /> CITY IIP PHONE LICENSE E <br /> Z L IV <br /> LT7 E*1 PLUMRNGCONTRACIOR MAIL ADDRESS CITY IIP PHONE LICENSEE <br /> � � x <br /> yy y CUSS OF WORK <br /> t" NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> I„I <br /> 4K CONTACT PERSON AND PHONE NO <br /> e 0 Gll C <br /> y '•V CONTRACT PACE OF WORK <br /> 0 H 0 DESCRIBE WORK AN SOUARE FOOTAGE INVOLVED , ^ -r <br /> En Hi t!/ ,7i7ii Y' /.�/� J �,•LlY <br /> PROPQSEou OF UI DWG/ '" I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> XO C'1„ / '1' . I, ( 'CTii APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 011-x, C7 FECAL SCRIPIOH OFP RTY(SHOWN OR ATTACH FOUR COPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ��yy WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> E�F1 6 LOT .�A BLOCK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> / , / AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Z rl gCg ��/�111-L G'9 ,f-C Tiue? OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> f� y z r /� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ( 'f� / OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> H y <br /> yF^'L L �Q! _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> En H CONTRACTORS LAW 18.27 RC1'I AND 296.200 WAC. <br /> IL7 t+(A SIGNATURE OFCONTRACTOR OR AUTKI IZED AGENT/ DATE I <br /> RI L*1 / 1 L . <br /> X /K'/. /./T2../ r I� <br /> HEA <br /> O EnF r r ADDRESS / G-%�//tC I/` I'te- ✓,�X1 -- <br /> 3 + 4V /ti j-` APPLICANTSCI RLI ESSLK:ENSENO ANDBUSINESSNAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FFE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) /0 A/C--NHNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> A� <br /> a LAVATORY(WASH BASIN) '0 L UNIT HEATERS-B.TU. M <br /> SHOWER S / CLOTHES DRYERS ' <br /> KITCHEN SINK A DISP VENTILATION FAN <br /> DISHWASHER 7 RANGE HOOD <br /> — �-- <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL METAL FIREPLACE A CHIMNEY o <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> Jz BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) <br /> A� SUB TOTAL $ SUB TOTAL S ' <br /> PERMIT $ PERMIT S __ <br /> _ TOTAL FEE S 1 TOTAL FEE $ <br /> FOR OFFICE USE ONLY: I z 7LPN <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PL CHECKNUMBER FE • Qls RECEIPT NO <br /> G7 <br /> USEIONE LOTAREA VACANT Sjm FEES VALUATION FEF_ <br /> I y BUILDING (I� „�� y 7 6 <br /> TYPE0ICOKISALIGNABLE 1 OF CDNSI ACTUAI an P.Rcr IIEOMLLKIG Win <br /> Al v /?-?I I PLUMBING <br /> SIZEOFBLDO bsA2 NO OF STORIES BASEMENT MECHANICAL fj '00 <br /> 1130 tSOa Gw.Y. <br /> OCCUPANCY LOAD FIRE SPRNKLERS REDD HEIGHT LIMITATION ADDITIONAL PLAN CHECK ✓Q I'�S <br /> ZI I— OTHER <br /> REASONFORSPRINKLERS --�/ �- <br /> STATE BUILDING SURCHARGE 7 �S-0 <br /> INTAKE RY MANS APPROVED BY CITY OF EVERETT PUBLIC WORKS 70 )eo <br /> LOCAL SALES <br /> ('l '7112 TAX CODE IS 3105 TOTAL 677 9 <br />