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APPLICATION FOR CONSTRUCTI'-N PERMIT „•IN'll <br /> TO BE COMPLETED IN INK-PLEASE PRINT <br /> C11Y Ot <br /> everett HEATING KI JGAS JELICTRIC <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNE _ MAIL <br /> _ A <br /> PHONE <br /> . 3�� F � <br /> r/es1/T� JYt4�Nf LiI %L'j•> ( f. <br /> IENANTAOI,: .VP eel.'.t '.Glp DRESS city ZIP PHONE <br /> ARyp;yyi DESIGNER M.A[R ATHIR SS /f • Cllr q 21P PHONE <br /> C 1'C 71,7 c r l ICT LLIu 7,10 lc lic. `Ibt 'S S'✓,2-/7F� <br /> 1j c�H GENETPLCONiMCTOR MA ADDRESS CITY/r ZIP PHONE LqICENSEE <br /> y �/'lxt1 � __7t)c['s�llrs 17Tc. _ �c`6ra,.s It"c `�?�02 5E7- 53/1!6/1// 7/1�'Pl Q99J� <br /> 9) MECRANICN CONTRACTOR MAILADDRES4 CITY ZIP PHONE LICENSE <br /> C H <br /> >Hto <br /> PLUMBING CONTRACTOR MAIL ADDRESS city ZIP PHONE LICENSE <br /> H 3 <br /> It n <br /> WORK <br /> CLA55 aF <br /> O S O �S NEW ADDITION ALTERATION REPAIR DEMOLITION WOODS70VEIFRPL INSERT BUILDING RELOCATION <br /> '� y IHr CONTACT PERSON AND PHONE NO <br /> y .,C� CONTRACT PRICE OF WORK / '�) '• `' _ <br /> mss[t'] DESCR/BE NORK AHO ARE FOOTAGE INVOLVED <br /> C7 `ell' J['/Ilea ���[/ .✓ � �PIN <br /> t7 PROPOSEDusE BunD I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> (ITN C) St AqN••.L L.E C'T T L S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> H - - PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ,Z H LEON DE IPTION OF PROPER"f NON'N BELOWOR AT1AyfOUR CWIE51 <br /> LOT BLOCK OF A/ /✓. / WORK WILL BE 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 /> gEA ///�1j4 l"l[`C y� L.- /✓ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> C] C N PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 1 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE. AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 298.200 WAC, <br /> I.3 0 CA SIGNATURE OF CONTRACTOR ORRAAA}}}111i1GGR/IZ],END AG T 0 E l yam/ <br /> PROJECT ADDRESS ( g 1410, Rel A41tetr 7�sa- <br /> / / O -jq /Ix �C APP[CANTi CO F It SSIICTNSFNG AND RUSINESS NAME <br /> PLUMBING LO C MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) IS ,VC-A/HNDLG UNITS-H.P. <br /> _• / BATHTUB _ FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) - UNIT HEATERS-811) M <br /> M / SHOWER r' - / CLOTHES DRYERS <br /> -� KITCHEN SINK 8 DISP _�' - VENTILATION FAN <br /> DISHWASHER / RANGE HOOD _ <br /> LAUNDRY TRAY WATERHEATER <br /> CLOTHES WASHER WOOD STOVE _ <br /> +. URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS _ GAS PIPING ' <br /> •' ROOF DRAINS-RAINLEADERS _ EXHAUST FAN <br /> SINK(SERVICE-BAR.ETC.) - i•..._i /-)c..•S I' o ' <br /> I <br /> SUB TOTAL $ SUB TOTAL E dam_ <br /> ' PERMIT S PERMIT E <br /> TOTAL FEE $ S S " TOTAL FEE E 90 ' <br /> FOR OFFICE USE ONLY: JS4 Do/m, <br /> FRONT SETB� - REAR SETBACK SIDE SETBACK CPE X UM8,n FEE./s7•A GA' RECEIPTND <br /> �r A ' mil 1)_7 <br /> 0-o3A- <br /> USE ZONE- LOl AREA VACANT SITE FEES VALUATION FEE <br /> ` O _ V155 BUILDING !7 - y <br /> TYPE Mt ISuTABII TYPI O,COM(ACTUN V N XodMrtNA4ulnn <br /> U nr ' <br /> ✓, .1 <br /> SIZE OBLDG NO OF STORIES BASEMENT MECHANICAL qp 00 <br /> +Z.. , I <br /> xcurANCr LOAD <br /> FAIL SPRNKLERSREGD HDIONr I IMITATION ADDITIONAL PLAN CHECK iP" <br /> N OTHER <br /> REASON FOR 4rnINMI f H) ' <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS Arrrroveo er CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> 7 Zy' TAX COBE IS 3105 TOTAL 77 <br /> ;` 8 <br />