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APPLICATION FOR CONSTRUCTION P,ERMu; YIHN 11 <br /> fAP EY gmn TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everett <br /> BUILDING DEPARTMENT O 0 HEATING SYSTEM: GAS ELECTRIC <br /> 259.881( <br /> DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAIL ADDRESS CRV ZIP PHONE <br /> �t �lao� lite r. 11DLD /1�« C�T,�r lctgao2- _,S3�i- Od yy_ <br /> TENANT MAA ADDRESS CITY � ZIpP PHONE <br /> ARCHITECT CR DESIGNER MAA ADDRESS . ,CITY 7iP PHONE -' <br /> hb Ari R E rn t* k1/rC�; 9X4633 /7a� <br /> GENERAL CONTRACTOR M ILS ADDRESS CITU DP PIlmE LICENSE <br /> Tiy/1LL'IC TA/UC (JJJX �.10/?OYF /y� <br /> MECHANICAL TRACTOR MAAADDRESS CI;) <br /> I ,,IP PHONE LI:ENSE• <br /> PLUMBING CONTRACTOR MAIL ADDRESS ^ITV ZIP PHONE LICENSE <br /> CLASS OF WORK <br /> NEW ' ADDITION ALTERATION REPAIR DEMOLITION I. WOODSTOVEIFRPL INSERT F i BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO. ISS�Li� <br /> CONTRACT PRICE OF YORK TLn�J�a,,4 �3 ja <br /> DESCRIBE WORK A%r)SOJARE FOOTAGE INVOLVED <br /> (//q3 s Srfi_ 46fl is en -A-5a- 47 <br /> PROPOSED USE OF BUILD! //� jf <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �'/noe (T)/I�/ r�} _ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> LE04 DESCRIPTION OF PROPERTY'SH6WN BELOW OR ATTACH FCU"COPIESI MROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> -�,' .` WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT eLoc<. of m� f"�a7e (]/ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTP..R 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 /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> PROJECT ADDREFS ` [ <br /> LIgLICANTSCin BUSINESS LICENSENO AND BUSINESS NAME <br /> PLUMBING MECHANIC AL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER I:LCSET(TOILET) , - AIC—AINNOLG UNITS—H.P. <br /> BATHTUB - if FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) , UNIT HEATERS—B.T.U. M ' <br /> SHOWER CLOTHESDRYERS I <br /> KITCHEN SINK 8 DISP I - VENTILATION FAN <br /> DISHWASHER I RANGE HOOD --� <br /> _ LAUNDRY TRAY WATER HEATER I <br /> _L CLOTHES WASHER I - WOOD STOVE ' <br /> URINAL <br /> METAL FIREPLACE 6 CHIMNEY I — <br /> DRINKING FOUNTAIN , FIREPLACE INSERT ) <br /> FLOOR GRAIN �' - HEAT PUMP I <br /> BACKFLOW PREVENTERS ; GAS PIPING I <br /> ROOF DRAINS—RA114LEADERS I EXHAUST FAN , <br /> SINK(SERVICE—BAR,ETC) Tonit <br /> I <br /> I T <br /> SUB TOTAL $ `; SUB TOTAL S <br /> PERMIT E PERMIT E <br /> TOTAL FEE $ / TOTAL FEE S <br /> FOR OFFICE USE ONLY: 077 /f9 <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN HECKNUMBER FII RECEIPTNO. <br /> ao �o x/00 30� 53 <br /> USEEZZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> BUILDING 9 : <br /> TYPE OF CO/NTS.ALLDWABLI TYPE O CCNS7 ACTUAL OtCWKv MI M MULM UMR <br /> d -N - <br /> '�_ S PLUMBING <br /> J I <br /> SIZE OF BLOC NO CY STORIES BASEMENT MECHANICAL IO <br /> X10 <br /> OCCUPANCY TOAD <br /> ADDITIONAL PLAN CHECK ' <br /> FqE 6PRNKlER9 REOD HEIGHT LIMITATION , <br /> i <br /> REASON FOR SPRINKLERS I <br /> STAT:BUILDING SURCHARGE A/I <br /> INTAKE BY PUNS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> !� TAX CODE IS 3105 TOTAI <br /> I �• <br />