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APPL.ICATIONA FOR CONSTRUCTJN PERMIT LtVL'TPII <br /> Ow Ewlgwn TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everett - <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC U 1 <br /> 259.8810 <br /> I DEMOLITION I I COMBINATION I BUILDING D(MECHANICAL I I PLUMBING SIGN <br /> IW/NEn MAIL ADDRESS CITY ZIP PHONE <br /> 1,gan 102 F, �I �� cJ{' S•A2o3 3SS-2 '9'A_z <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> .RIIEIMI.COHIIMCNNI MAIL ADDRESS CITY 71P PUMP IICf NCfR <br /> 610E'CII,A/N�CAALcmin/AC_IOZn�,L �1 �M/AII.ADDRESS I7 CITY ZIP /� -PHONE LICENSE R'1 (y(��(f <br /> �0�- v—�-�PHON � LCENSEIU jigt Sg _L../J <br /> ItUMBNKICONTDACTOn MAA ADDRESS CITY ZIP <br /> CLASS or WMK <br /> I NEW II-�<DDITION I I ALTERATION I I REPAIR I I DEMOLITION 1 1 WOODSTOVE/FRPL INSERT CI BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO <br /> CONTMCT PRICE Or WORK2oa <br /> R�nNIE W(NIK 1 SQUARE FOOTAGE q XVEO <br /> a 5 okP erqr 1 Lr <br /> PROPOSED USE a BUILDING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> I EDAL OEScriPTIDNor PROPERTY(SHOWN SELOWOR ATTACH roan COT'IESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> IGT _ BLOCK of 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 <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 296.200 WAC, <br /> I <br /> SIGNATURE OF <br /> ) u <br /> OR AUTHORIZED AGENT DATE <br /> o.l �oap S x <br /> PnEcr ADDRESS ss <br /> APPLCANTS CITY BUSINESS LICENSE NO.ANO BUSINESS NAME <br /> MB-PWI 0 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C-A/HNDLG UNITS-H,P. _ <br /> BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) 1 UNIT HEATERS-B.T.U. M ; <br /> SHOWER ' CLOTHES DRYERS I <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ' I <br /> DISHWASHER I RANGE HOOD I <br /> LAUNDRY TRAY ' WATER HEATER ' <br /> CLOTHES WASHER I WOOD STOVE R <br /> URINAL ' METAL FIREPLACE 6 CHIMNEY ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT I <br /> FLOOR DRAIN ' HEAT PUMP I <br /> BACKFLOW PREVENTERS ; / GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS I EXHAUST FAN 1 <br /> _ SINK(SERVICE-BAR,ETC.) ; <br /> I � <br /> I , <br /> _ SUB TOTAL S i SUB TOTAL $ <br /> PERMIT $ I PERMIT S I <br /> TOTAL FEE S ' TOTAL FEE $ 3p 1 <br /> FOR OFFICE USE ONLY: <br /> RIIONT SETBACK REAn SETBACK SIDE SETBACK PLAN CHECK NUMBER I1f RECEIPT NO <br /> fISEZONF LOT AREA VACANTSIIE FEES VALUATION FEE <br /> BUILDING <br /> WI M CONIS MUMARI( TYPE M CONST ACTUAL RffiRAIKY w MPKIIR MR, - - <br /> °M"� PLUMBING <br /> I <br /> SIZE or BLDG IO OF STORIES BASEMENT MECHANICAL <br /> 3a ;OCCUPANCY LOAD FIRE SP"WLEns"EUD IKgni LndnnlKkl ADDITIONAL PLAN CHECK <br /> OTHER i <br /> REASON FOn SPnWLER5 <br /> STATE BUILDING SURCHARGE ' <br /> INTAKE BY PLANS APPROVED BY CITY OF EVEREIT PUBLIC WORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL <br />