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.I <br /> APPLICAViON FOR CONSTRU%;TION PEEMIT <br /> everett <br /> CI EYP,p,nn,l <br /> cIry of <br /> everett <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> i I DEMOLITION I I COMBINATION DC BUILDING Ae-MECHANICAL kPLUMBING 1 SIGN <br /> OWNER MAL ADDRESS CITY ZIP PHONE <br /> 1yow e4day - —y C�,aP. /6 u- [ASW S'E. Gizy iftc a *iv/?- 33$-/SiBG <br /> TENANT MAL ADDRESS ITY ZIP PIgNE <br /> ARCHRECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAL ADDRESS CITY ZIP PHONE LICENSE <br /> MECHANICAL CONTRACTOR MAL ADDRESS CITY ZIP FNONE LICENSE E <br /> elLd%4' 1 #dff77PJ6- <br /> PLUMBING CONTRACTOR MAL ADDRESS CITY ZR' PHONE LICENSE <br /> RfGETSOL/A� Puc..�3fA�G- <br /> CLABB OF WORK <br /> k NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVEIFRPL INSERT I I BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR mtrRIOR REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> CONTRACT PRICE OF WOIIN: /t'1 '1 R <br /> DESCRIBE WORK AND SOIIARE FOOTA INVOLVED <br /> / _ it 78 <br /> PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> f1A)6 jZ f� �.�rD L) APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT _ BLOCK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> z aGIff6 b TET2 R blvz 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 298.2DO WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> /US — L�arPG. _l 2f U <br /> PROJECT ADDRESS <br /> APPLICANTS CIT Y PJSd1ESA LICENSE NO AND BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> 70. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C-A/HNDLG UNITS-H.P. <br /> 'L BATHTUB yr, ' FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY WASH BASIN) I UNIT HEATERS-B.T.U. M <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK A DISP ; VENTILATI FAN _ <br /> DISHWASHER f RANGE HOOD <br /> LAUNDRY TRAY _L WATER HEATER ' <br /> CLOTHES WASHER I WOOD STOVE I <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 F <br /> I <br /> SINK SERVICE-BAR,ETC.) <br /> Aotj hump floor )fkr1_T4 <br /> I � <br /> I I <br /> I , <br /> SUB TOTAL $ I SUB TOTAL S Ito <br /> PERMIT $ PERMIT S i <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FRONT SETBACK REAR SETBACK L SIDE SETBACIS ' E PIAN CN RECEIPTN <br /> NNUAIBER FEE O <br /> 20 za $ 90 sl ;OV S 3 8 S' 1-7 <br /> USE 1 ELOT AREA VACANT SITE FEES VALUATION FEE <br /> Z. -?,06-01 1 1 YES I I NO BUILDING p � lar, <br /> IN CONST�IOWARE TYP(OT CONST/1CJUAL IKLUMK. Ko ormugmis ; <br /> //,„,LVA//'' -N PLUMBING 6s �06_ <br /> 811E OF BLW. NO OF 6TORIEF BASEMENT MECHANICAL <br /> I I YES S(NO ^- <br /> OCCUPANCYLOAD FIRE SPRNNLERS REO'D HEIGHT LIIjIIIT OTHER <br /> `4V <br /> I I I YES NO STATE BUILDING SURCHARGE � <br /> REASON FOR SPRINKLERS <br /> STATE ENERGY SURCHARGE i <br /> APPLICATION AL:C P, PLANS APP vepeY CITY OF EVERETT PUBLIC WORKS C{J <br /> LOCAL SALES — <br /> TAX CODE IS 3105 TOTAL ' <br />