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APPLICATION FOR CONSTRUCT eON PERMIT <br /> Pw rwrgwn �. �+c.LT everett <br /> OE' <br /> e e <br /> verett <br /> BUILDING DEPARTMENT <br /> 259.8810 TO DE COMPLETED IN INK–PLEASE PRINT <br /> i ; DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING i SIGN <br /> OWNER MAIL ADDRESS CITY ;•v PHONE <br /> wooclljaycn �fcvores IS <br /> IENAN /03 � G 4'6 396,ygnwof <br /> I MAIL ADDRESS ,ry ZIP 9 9 <br /> PHONE <br /> ARCHITECT OR DESIGNER MAIL ADORI i 5 CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADOBE'S CITY ZIP PHONE LICENSE <br /> yoodl)gVrm Holes P. 0. 43% IV3 _4y•/owDoc/ n_/s. 'Sore j-'va .3 i9 lr/oo�//i'H/7Yp8 _ <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSER <br /> OLUMBNGCONTRACTOR MAIL ADD'.ESS CITY ZIP PHONE LICENSER <br /> CLASS OF WORK <br /> YINEW I ADDITI'IN iJ ALTERATION REPAIR DEMOLITION Wr STOVEIFRPL INSERT LI BUILDING RELOCATION <br /> TENANT NAPROVEMEFTOR ,ERIOR REMODEL ONLY CONTACT PERSON Af JrruLc NO, <br /> CONTRACT PRICE OF WORT /C Cl/'_ p1 <br /> DEbCR1Dr�`RRKK AND SQUARE FOOTAGE INVOLVED l e O _ —� <br /> . S 7 y� ---,) 9� q <br /> PROPOSED USE Ore DING <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S q e APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DE ipN OF PROPERTY ISH BELOW OR ATTACH FOUR COPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOT_.�;L_ BLOCK OFDI e rn/o0 e/'raC WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> 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'.AW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 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 /> t <br /> Slf;NATURE OF CONTRACTOROR AUTHORIZED AGENT DATE <br /> PnWFCTADDRESS - X � 7//z" <br /> IS ,.e fC APPLICANTS CITY BUSINESS LICENd NO.ANDeUSINESSNAME <br /> PLUMBINr, MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) I A1C–A/HNDLG UNITS–H.P. <br /> I BATHTUB FORCED AIR SYSTEMS–BTA). M E.A. <br /> LAVATORYWASH BASIN) <br /> ) _ —} UNIT HEATERS–B.T.U. M , <br /> sC SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP i VENTILATION FAN i— E <br /> I DISHWASHER ' / RANGE HOOD �— <br /> _ LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE ; <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY �— <br /> DRINKING FOUNTAIN I _ FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP �— <br /> BACKFLOW PREVENTERS I GAS PIPING <br /> ROOF DRAINS–RAINLEADERS I EXHAUST FAN I <br /> SINK)SERVICE–BAR,ETC.) <br /> I <br /> I <br /> I <br /> I <br /> I <br /> � T <br /> SUB TOTAL $ ; SUB TOTAL f ' <br /> PERMIT f PERMIT E �— <br /> TOTALFEE $ TOTAL FEE $ 1 4O ' <br /> PROM�BZACN REAR SETBACK SIDE SETIACK, �/ PLAN CK NUMBER FEE RECEIPT NO. <br /> W1 <br /> USE Z NF LOT ARA VACANT SBE FEES VALUATION FEE <br /> .Z ! YES C5 NO > , <br /> TYPE Or CONST ALLOWARL AHH <br /> LOWARL TYPE Of CONST ACTUAL I%NMACY wo, IA4 uM Is BUILDING r/9 Al <br /> 0A `"Clul' / PLUMBING _ J <br /> SIZE OF BLDG YJ Y fj. NO OF STORIES BASEMENT I <br /> MECHANICAL G I <br /> / 7 + ❑ YES R'NO <br /> OCCOANCYLOAD FIRE SPRINKLERS REO9 HEIGHTLIMITATION OTHER <br /> }� 2$ ;TION <br /> R FOR SPRINKLERS IJ VES NO STATE BUILDING SURCHARGE t' �S-0 <br /> i <br /> STATE ENERGY SURCHARGE ' <br /> APPLICATION ACC BY 9PLANSAPPROVEDBY CITY OF EVERETi PUBLIC WORKS <br /> LOCAL SALES 3D'k} <br /> Q 12 TAX CODE IS 3105 TOTAL 2-3 S– <br /> L <br />