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APPLICATION FOR CONSTRUCTII.d PERMIT <br /> .0 BE COMPLETED IN INK—PLEASE PRINT <br /> mFEL.,Pre.R <br /> CITY OF }} _— <br /> eVeirett HEATING SYSTEM: GAS ❑ELECTRIC ❑._ <br /> BUILDING DEPARTMENT <br /> y 259.8810 �y TNAw <br /> JD <br /> 3 ti El DEMOLITION COMBINATION_ )N BUILDING ❑MECHANICAL PLUMBING ❑ SIGN <br /> LMR ADCRESS CITY IP PHONE <br /> rzc►�ri�rLe�'Ti� _��OzO /1 }gym Y �ix'r/'/A �aea �sD9�s3i�DL�y <br /> 1'3 MAR ADDRESS CITU -7 21P PHONE <br /> H 3 <br /> `C r7 CSI TENANT <br /> O CT O <br /> yRCHIDESIGNER TECT OR LIAR 0 ESS CITY 21P PHONE <br /> H A <br /> y z H DAi SCh F } x�nn� /rY/4ri�1 <br /> O/ CONIRSl�MAIL US ADDRESS ZIP PHONE LICENSEI <br /> � TOR KK 7iPU /1099S.A <br /> MECHAHK:AL ONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br /> Mcg <br /> CDY C] <br /> PLUMBING CONTRACTOR IAAR ADDRESS CRY IIP PHONE LICENSE <br /> H <br /> H <br /> $OF WORN <br /> O CAf�NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR LI DEMOLITION El WOODS,OVEIFRPL INSERT <br /> H ❑ BUILDING RELOCATION <br /> H CONTACT PEI.SON AND PHONE N0. <br /> co <br /> C3 <br /> .m CONTRACT PRICE OF V/ORK <br /> 1'3 y DESCRIBE K AND6WARE FOOTAG INVOLVED ` fn � CM �r3- / 47 <br /> ��n f % fV E YIIV <br /> PNDPOSEO USE OF Bu'. I HEREBY CERTIFY THAT 1 H:'VE READ AND EXAMINED THIS <br /> SSI �f An2It Z! lCEY1L'� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LgpN.of RIPTION Of PROPERTY BELOW TTACN WRCOPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> /tel A # / WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> L BLOCK OF Aly 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 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 /> APPIIf :ION IS MADE AND I COMPLY WITH THE STATE I <br /> CONTRACTORS LAW 1827 RCW AND 286.200 WAC. I <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> X <br /> PROJECT ADOREFS APPLICANTS CITY BUSINESS LCENSE NO AND BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> j NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> NATER CLOSET(TOILET) I " A1C—A/HNDLG UNITS—H.P. ' <br /> / BATHTUB ' - FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> 1�=' LAVATORY(WASH BASIN) ;= UNIT HEATERS—B.T.U. M I <br /> SHOWER CLOTHES DRYERS ' <br /> f KITCHEN SINK&DISP ;— 3 VENTILATION FAN <br /> DISHWASHER — RANGE HOODWATER <br /> ' <br /> LAUNDRY TRAY �—� _ / WOOD STOVER , <br /> �► CLOTHES WASHER <br /> METAL FIREPLACE 8 CHIMNEY <br /> URINAL <br /> DRINKING FOU14TAIN I FIREPLACE INSERT I <br /> FLOOR DRAIN ' HEAT PUMP ' <br /> Ll BACKFLOW PREVENTERS i GAS PIPING <br /> ROOF DRAIN^r-MINLEADERS i EXHAUST FAN ' <br /> SINK(SERVICE—BAR.ETC.) flo <br /> I <br /> I I <br /> I ' <br /> � I <br /> ,_ EUB TOTAL { '— SUB TOTAL $ ' <br /> I1\` I <br /> PERMIT S PERMIT S <br /> TOTAL FEE S TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> fNpIT SETBACK REAR SETBACK BBIE SETBACK nBER IEE RECEIPT NO. <br /> zo g- .1Jum IDNE LOT AREA VACANT BITE S VALUATION FEElz �.Q� • QTYPE OF CONTS.AMOWASU TYPE OF CDNST.ACTUAL ELGILAKl MROMMKLBRiF_ I <br /> SIZE OF SLOG. NO.OF STORIES BASEMENT�OLAN CHECK OCCUPANCY LOAD FIRE SPRINKLERS RE00 HEIGHHTTLKUTAIION <br /> JO ! J OTHER i <br /> REASON FOR SPRINKLERS I <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PWIS APPROVEDBY CITY OF EVERETT PUBLIC WORKS i! <br /> LOCAL SALES <br /> Jif �9��1L TAX CODE IS 3105 TOTAL Q <br />