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APPLICATILA FOR CONSTRUCT _JN PERMITFLI <br /> IAP Ewrown TO BE COMPLETED IN INK-PLEASE PRINT <br /> CITY OF <br /> everett I HEATING SYSTEM: U GAS U ELECTRIC ❑ _ <br /> BUILDING DEPARTMENT <br /> 259.8810 � � <br /> (1 DEMOLITION COMBINATION (.'BUILDING MECHANICAL PLUMBING SIGN <br /> OWNERCITU 21P PIK)NE <br /> �fal 7,e <br /> ,j <br /> /)i(l<MAK ADORE88 <br /> 3 29—Can 0, S r C2/e,-e!T 9f 2v3 3s s= ?20L 2- <br /> TENAQA� MAIL ADDRESS CITY ZIP PHONE <br /> ��� ( B ,,alr 3Z/CG CVe,-ell 13i8Lo ( 252-�xy� <br /> I�CNITECT OR DESKLNER MAL ADDS SS <br /> Co.. ZIP PHONE <br /> GENERALCONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/ <br /> /TEf lei D <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br /> PLUMBINGCONTRACIOR MAK ADDRESS CITY ZIP PHONE LICENSE/ <br /> CLASS OF WORN �' <br /> I I NEW 1 1 ADDITION LyALIERATON 1 1 REPAIR i I DEMOLITION I ! WODSTOVEIFRPLINSERT BUILDING RELOCATION <br /> .I C�ONTTACT PERSON ANLDIPHONE <br /> CONTRACT PRICE OF WORK L7 ' U 0 <br /> DESCRIBE WORK AND SQUARE FOOTAGE V <br /> ve <br /> PROPOSED USE OF BUILD INq� c 4e,� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> fl <br /> f OG-�-� ✓ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> RIPTM]N OF PROPERTY ISMOWN BELOW CAITACNfWRCOPIE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK LSPECIFIED <br /> LOTVfM 37•+3 3BLOCK of NOT. THE GRANTING OF PERMIT DOES NOT PRESUME O GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGUCNSTRUCTION OR THE <br /> PERFORMANCE OF ONS RUCT ON.UTHATLI AIA 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 288.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> ' PROJECT ADDRESS <br /> s�L(•(^- &`, �r J , 4�f` APPLICANTC CITY 81 6S LICENSEN AVD SUSMESS NAME <br /> 1 1 lJ - <br /> 7 PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM FEE NO. TYPE OF EQUIPMENTFEE <br /> WATER CLOSET(TOILET) I AIC—A/HNDLO UNITS—H.P. _ <br /> BATHTUB _ _ _ ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M I <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP I VENTILATION FAN ' <br /> DISHWASHER RANGE NOD <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHESWASHER I WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS ' EXHAUST FAN ' <br /> SINK(SERVICE-BAR,ETC.) <br /> 1 <br /> i I 1 <br /> 1 I <br /> , 1 <br /> SUB TOTAL S SUB TOTAL $ _ <br /> PERMIT S I PERMIT $ _ <br /> TOTAL FEE $ ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACLf PLANCHECN UMBER FEE RECEIPT NO <br /> 01 201 F 9rJ a ss s� 3<'/L) i4 af� <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE •,+ <br /> .Z no BUILDING Z J SY; 00 <br /> TYPI OF CONTE ALLOWABLE TYPE ME SI ACIUAL u[tlA'AAFr AO QEMI IARPMIA 1 <br /> Z PLUMBING <br /> SIZ5^BLDG SIt NO MBIORIEs BASEMENT MECHANICAL 1 <br /> K flx^J- <br /> a J �— <br /> OCCUPANCY LOAD FIRE SPRNKLERS PEGG IIEI014T I IMITATION ADDITIONAL PLANCHECK <br /> 2$� - <br /> OTHER � <br /> REASON OG SPRINKLERS �— <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVED BY CI TY OF EVERETT PUBLIC WORKS <br /> Q Ll LOCAL IS 31 <br /> 7 `T TAX CODE IS 3105 TOTnI <br />