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APPLICATION. FOR CONSTRUCTIJN PERMIT "`" d' <br /> IM EvFryRHrn TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> 1-3 o everettHEATING SYSTEM: GAS U ELECTRIC C3 __ <br /> py BUILDING DEPARTMENT <br /> x 259.8810A <br /> y ti ❑ DEMOLITION COMBINATION BUILDING ❑MECHANICAL i PLUMBING ❑ SIGN <br /> K 4 �� M R ADDRESS -YOM n rnTMs�c�. n� g`��e 53i�d/1/y <br /> !/Irl'[n am• —� nP —7 rNDNE <br /> TENANT 1'AR ADCAESS <br /> _ z <br /> ARCHITECT OR DESIDNERYIL� D E56 /r � ZIP � _�ay <br /> [[fxfy�� A111- s n/ <br /> ZIP PHONE LICENSE <br /> OyNUL CONTRACTOR <br /> o H zPa <br /> 9% 21P PHONE <br /> MECNWICAI TMCTOR CITY 5 <br /> " <br /> V E] <br /> uL 555 <br /> i, CITY 21P PHONE LICENSEI <br /> yPLUMa'NG COI TRACTOR MAIL ADDRESS <br /> Hy <br /> �yCA a WDRK <br /> O N IIEW Cl ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION .'7 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> 5 I CONTACT PERSON AND PHONE NO. <br /> (iJ LONTMCT?RICE OF W011R <br /> y O DESCRIBF KANDSWARE FOOTAO INVOLVED 1 —� ��3- d <br /> CA COn sCrt <br /> PROPOSED USE a BUILFIG I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS <br /> SI lir /� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L )of AIP_TgN OF PROPERTY I OM BELOW ?TACH OUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> eLocA of u 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 I <br /> PERFORMANCE OF CONRTRUCTION.THA(I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATI... IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RC ND 296.200 WAS. <br /> SIGNATURE OF CON ZED AG T DATE <br /> x i <br /> - \ PROJECT ADORES/ APPL M SCITYBUSINESSLICENSENO.AND BUSINESS ME <br /> PLUMBING FEE <br /> Np, TYPE OF FIXTURE OR REM FEE NO. TYPE OF EQUIPMENT FEE <br /> W1TER CLOSET(TOILET) I — A/C—AfHNDLG UNITS—H.P. _ <br /> / B/ITHTUB �J FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) I� UNIT HEATERS—B.T.U. M <br /> SI-OWER '— CLOTHES DRYERS <br /> ' VENTILATION — <br /> KITCHEN SINK 6 DISP ' FAN <br /> / DISHWASHER - <br /> ' WATER HEATER ' <br /> 1 LAUNDRY TRAY ' -- <br /> CLOTHES WASHER I — WOOD STOVE <br /> URINAL ' / METAL FIREPLACE 6 CHIMNEY ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN ' <br /> HEAT PUMP ' <br /> I BACKFLOW PREVENTERS <br /> GAS PIPING <br /> ROOF DRAINS—RAINLEADERS ' EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) ' 4-22" 1 <br /> I <br /> i <br /> I <br /> I <br /> ur� SUBTOTAL Y '__ <br /> Il\ SUBTOTAL S f <br /> PERMIT $ ' PERMIT $ <br /> ' <br /> TOTAL FEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REM SETBAC� SIDE SETBACK PLAN CHECK NUM R FEE RECEIPTfq. <br /> USE ONE ' LOT MEA/J VACANT SITES FEES VALUATION FEE <br /> BUILDING <br /> TYPE OF CONTI.AUDWAIL TYPE OF CONFT.ACTUAL oGMIKCT YO OEAWwIMxn 1^ <br /> V� - / PLUMBING <br /> SME OF BLDG, No.OF STORIES BASEMENT MECHANICAL ' <br /> 15 <br /> OCCUPANTS lOAO FIRE SPRNKLERS REUM EHEPOIKOT LIMITATION ADDITIONAL PUN CHECK i <br /> q I <br /> OTHER <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE <br /> I <br /> INTAKE BY <br /> PLANS APPROVED BY CITY0 EVERETT PUBLIC WORKS i <br /> Jg LOCAL SALES <br /> 9J t TAX CODE IS 3105 TOTAL -7/ <br />