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v1 <br /> APPLICATION FOR CONSTRUCTiiiN PERMIT CVCIL7l( F <br /> e � t <br /> T,P,p,pP„ TO BE COMPLETED IN INK-PLEASE PRINT <br /> CITY OF <br /> evere <br /> BUILDING DEEPP ARTMENT HEATING SYSTEM: GAS ❑ELECTRIC Cl-- <br /> T(>j 259-8810 <br /> yyF..•, <br /> .O t� i-i DEMOLITION COMBINATION BUILDING i j MECHANICAL ❑PLUMBING ❑ SIGN <br /> y� 0 N5fit d � �n AooRFsr. 926 Y . �.$ PHONE <br /> 1..1 ';. _L/1LY',,/. I I `(Ty_ViJ��iF'/J•Z `.�g 6,s s.3Y d�4 <br /> H h 1f.NANT MAIL ADDRESS CITY ZIP PHONE <br /> O D7 ARCHITECT OR CESgNER AA DESS CRY ZIP PHONE <br /> Pt F-4 HQED �f��j��/CONTRACT�/ a��Th��I ,� err �r -)7P <br /> /moo[ K J'7 L1 US ADDRESS ZIP PHONE LIC����E//���� <br /> O H MECHAN AItONTRACTOR MAI ADDRESS CITY ZIP PHONE LICENSES <br /> � LCTIJ8 <br /> Q. n PLUMBING CONTMCT39 MAR ADDRESS CITY ZIP PHONE LICENSES <br /> H <br /> F4 H <br /> H H f NOF WORK <br /> NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> � �fA CONTACT PERSON AND PHONE NO <br /> ['1 CONTRACT PRICE OF WORK <br /> 0 C� E RK AN�6UUARE FOOiAO IN - - <br /> -' <br /> PROPOSED USE OFBun r I HEREBY CERTIFY THAT I HAVE RLAO AND EXAMINED THIS <br /> ,SI o lF / 1?l yy -enl LF� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LODE RIPI'M OF PROPERTY( OWN BELOW OR TTACH OUR COPIES) _ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> / ) D) # / WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> I BLOCK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING I:ONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION ; MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 AND 298.200 WAC. <br /> i 6gNAlURE OFC A ,,/}IT EDA9W DATE <br /> f FRW ECT AODRE99 �I <br /> n .. L, APPL 79L U 9LIC 9E NO ANO BU9INE AME <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> 11 '1 WATER CLOSET(TOILET) I- A/C-AMNDLG UNITS-H.P. <br /> I BATHTUB "' FORCED AIR SYSTEMS-B.T.U. M E.A. �— <br /> LAVATORY(WASH BASIN) Il UNIT HEATERS-B.T.U. M <br /> SHOWER Jam'- CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> DISHWASHER r RANGE HOOD I <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WASHER r WOOD STOVE I <br /> URINAL <br /> METAL FIREPLACE d CHIMNEY 30 <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ; <br /> FLOOR DRAIN & '- HEAT PUMP <br /> �low'=' BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS-RAINLEADERS I EXHAUST FAN I <br /> SINK(SERVICE-BAR,ETC.) I� <br /> I ' <br /> I , <br /> I � <br /> SUB TOTAL f i' SUB TOTAL f <br /> I` ` PERMIT f I PERMIT $ <br /> TOTAL FEE f ' TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> f110NT SETBACK REAR BETBACK SIOE 9ESTBAER FEE O �I RECEIPT.1/058 � <br /> �_ <br /> USEZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> �_ <br /> BUILDING II <br /> TYPEIXCON75 ALLOWABLE TYPE IXCON6I ACTUAL OLOMSCT AO afMTIIxN VAHF Io 03 <br /> PLUMBING <br /> 6Qf.OF BtDO <br /> NO Of STORIES BASEMENT I <br /> 31,3 2 J MECHANICAL <br /> iS Si f:dR <br /> OCCUPANCY LOAD FIRE BPRNKLERS REOU HEgNrT�LWITATgN <br /> ADDITIONAL PUN CHECK -T <br /> A A/10 OTHER <br /> REASON FOR SPRINKLERS I <br /> STATE BUILDING SURCHARGE <br /> WTAKE BY PUNS APPROVED BY CITY OF EVERETT PUBLIC WORKSLOCAL I <br /> J� 2/1/4L SALES <br /> TAX CODE S3105 TOTAL <br /> I <br />