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i <br /> A7 PLICATIOA FOR CONSTRUCThJN PERMIT <br /> 4 TO BE COMPLETED IN INK—N'-EASE PRINT <br /> RIF EN'+rgrW <br /> CITY OF <br /> e'verett H,T,.iYSTEM: GAS UELECTRIC U <br /> BUILDING DEPARTMENT <br /> No 259.8810 <br /> H�L ❑ DEMOLITION j� COMBINAT/I�O ❑ <br /> /1N yy�K BUILDING MECHANICAL ❑PLUMBING 7/SJI�GN/ k <br /> H H i f�•� //YZ IL ADDRESS 21P � PHONEPHONE <br /> 5-,3 -d <br /> rG H 0 TENANT MA0.ADDRESS CITY <br /> FU �FO AIAII_+D E65 Y1 e Y J� � In PNDNE�A'1 +� Iy, <br /> 1-3 <br /> TA HI ARCHITE�DESgN�L.. / G / r l� _ r" �AZJ'1�1 LLT7 ZIP y - /� / <br /> Qzo DD MAR ADDRE6 CITY ZIP PHONE lgEN6E• S <br /> H C7 O •ER ,COONNTTR.ACTIOOR TeyA IW <br /> o r� /T I�/I Y/r/L U% LJ uS. ` DRY :IP PHONE 71 VV Ll� <br /> L CENSE F <br /> -L� c MECHANICAL TRACTOR MA0.A[gRE55 <br /> MM <br /> FFFL•••]111• C-1 ' <br /> :r H r� PLUMBING CONTRACTORIMI�NDDRE66 CI 21P PHONE— LICENSE i <br /> •[,mss H FrZ'�J <br /> H HOF WORN <br /> 1y y EW ❑ ADDI110N ❑ ALTERATION El REPAIR Cl DEMOLITION ❑ WOODSTOVE/FPPL INSERT L7 BUILDING RELOCATION <br /> 5�y CONTACT PERSON AND PHONE NO. I' <br /> CONTRACT PRICE OF WORK <br /> DESCRIBE" <br /> TAGfINVDLVED -McMEnT na_Ti.onovtIS 6 • <br /> � � 7 <br /> PT) <br /> U7BU I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S, � �1w ZLrsi CEIL''e APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> P <br /> L DE 'RIPTgN Qi PROPERttI BELOW OR TTACN WR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> BLS OF NOT. <br /> LLS+Y AUTHORITY TO VIOLATE OR CANCEL THE FROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORM.INCE OF CONSTRUCTION.THAT I AM AUTHORIZED DY THE <br /> ` OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ?�sw� l ly3s��1�1 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> r CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> fd LJ� X <br /> PRWECT ADDRESS APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br /> C'I PLUMBING MECHANICAL ' <br /> NO. TYPE <br /> IF FIXTURE OR ITEM FEE <br /> NO• TYPE OF EOUIPMENT FEE <br /> ' WATER CLOSET(TOILET) I _ A/C-T6UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-BTU. M E.A. <br /> r <br /> LAVATORY(WASH BASIN) r " UNIT HEATERS-B.T.U. M <br /> c� SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ' VENTILATION FAN <br /> r - RANGE H ' - <br /> DISHWASHER I <br /> LAUNDRY TRAY ' WATER HEAT ER <br /> r I <br /> CLOTHES WASHER r WOOD STOVE <br /> I METAL FIREPLACE 6 CHIMNEY <br /> URINAL ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ' <br /> HEAT PUMP <br /> r� I FLOOR DRAIN BACKFLOW PREVENTERS GAS PIPING - <br /> t EXHAUSTFAN <br /> DOFS-RAINLEADERS I <br /> RDRAIN ' <br /> d <br /> SINK(SERVICE-BAR,ETC.) r <br /> N <br /> I <br /> ' I <br /> SUBTOTAL $ r <br /> SUB TOTAL $ ' <br /> f r PERMIT $ <br /> PERMIT ' <br /> TOTALFEE E ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO <br /> FRONTSETBACK REARSETBACK SIDE SETBACK PLAN CHECK NUMBER FEE <br /> � 5 Jam., . <br /> USE I E LOT AREA VArANT SITE FEES VALUATION FEE <br /> -Z . o <br /> BUILDING ' - <br /> rYPEaLaRS.ALLDYMILE TYPE OF T.ACTVA FLRIMILY IIOawAulxownF '_ <br /> q I PLUMBING <br /> VI _ <br /> SIZE OF BLDG. NO.OF STORIES MENT MECHANICAL ' <br /> JIM <br /> r <br /> ADDITIONAL PUN CHECK <br /> OCCUPANCY LOAD FIRE BPRNNLEPS REDO NEgNT LIMITATION ; <br /> _ j <br /> OTHER <br /> REASON FOR SPRINKLERS ' <br /> STATE BUILDING SURCHARGE <br /> r <br /> INTAKE BY PLANS APPROVED BY CITY DF EVERETT PUBLIC WORKS I <br /> J#4LOCAL SALES 5 <br /> U 192 TAX CODE IS 3105 TOTAL Lggi <br />