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APPLICATION_ FOR CONSTRUCTI �N PERMIT <br /> IRBeeroJPeR TO BE COIAFLETED IN INK-PLEASE PRINT <br /> CITY OF <br /> everett HEATING SYSTEM GAS J EI ECTRIC J <br /> BUILDING DEPARTMENT - <br /> 259-8810 <br /> pw DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> IP <br /> OMER MAIL ADDRESS aptir- 98&O2 •• ,,�7 pp) // <br /> �f p1'OOEOb <br /> �f lU 1Cn L ADD Foal ii ' <br /> TENANT MAR ADDRESS CITY PP PHONE <br /> ARCHITECT O "IGNER MAR ADORESS GITr TIP P7Es—��� <br /> 14�A/ ('anSucTf� <br /> GENERAL TRACTOR MAK ADDRESS CITY 21P PHONE INCENSE I <br /> fis Dl�AJFJ� PNOIE INCENSE A <br /> `Jo z� MECHANICAL CONTRACTOR MAK ADDRESS CITY ZIP <br /> Ht VA)5 Jki 121st SIA Lunn `18037 �d5-393t� FM2IZHT /37 pU <br /> r � PLUMBING CONTRACTOR MAIL CRY ZIP PHONE LICENSE If <br /> y z ouA) as t -9 J,E�f TS P141�Z <br /> NABS Ci WORN <br /> O x O NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVElFRPI INSERT BUILDING RELOCATION <br /> C TACT PERSON AND PHONE NO <br /> a <br /> z CONTRACT PRICE OF WORK '� 000 E 7NQrYlAS a2 LsHtauc <br /> Oz <br /> ycl <br /> DESGRIBEWOiK AND SQUARE FOOTAGE=NVOIVEO _ <br /> �;d 08PROVBED USE Of BUILDING Q I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 0.1:73 n APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> HPROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DE SCRIPTION OF PROPER TV SHOWN BELOW OR ATTACH VOID COP IES I WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> CA-' H = LOT- _ BLCCX Of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> y y AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of ANY <br /> �lJ "�' �1�C DI = OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> n /L PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> dti <br /> ❑ OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 3 LO*)M APPLICATION IS MACE AND I CCMPLY WITH THE STATE <br /> tt�FiiI <br /> Z H Cn CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> H 0 E SIGNATURE'Or CONTRACTOR OR AUTAGAIZED AGENT DATE <br /> J►c� //ST PLF 5,� I/612E?T X uC o►s000_ <br /> PROJECT ADDRESS L55L��+L�DNS`LT�C�1t21 <br /> APPLICANTS C Y BUSINESS LIC114SE NO ANUBUSINFSSNAME <br /> MECHANICAL <br /> PLUMBING <br /> 40. TYPE OF FIXTURE OR ITEM FE I N0. TYPE Of EQUIPMENT FEF. <br /> WATER CLOSET(TOILET) -7_ AIC-A'HNDLG UNITS-H.UNITS-H.P.Z BATHTUB _ FORCED AIR SYSTEMS-BTU. M E.A. <br /> 3 <br /> I UNIT HEATERS- <br /> LAVATORY(WAHEATERS-13111. M <br /> SHOWER CLOTHES DRYERS <br /> HEN SINK 8 DISP <br /> _ VENTILATION FAN ' <br /> KITCb —T— <br /> / DISHWASHER _�_, <br /> RANGEHOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ W000 STOVE - <br /> ,� URINAL f METAL FIREPLACE A CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS Hj EXHAUST FAN <br /> SINK(SERVICE-BAR.ETC.) _ <br /> SUB TOTAL $ 5 _ SUB TOTAL f ' <br /> +� PERMIT S - TORAHFEE E <br /> _ TOTALFEE $ TOTAL <br /> FOR OFFICE USE ONLY: _ <br /> FLIGHT SETBACK REARSFTBACX SIDE SEIBACK RAM CHECK NUMIIFP FEr RECEIPT NO <br /> �F 2.0( 5A 9e ? .3 IJA5 ic_ 80 <br /> USE ZC — LOT ARIAM VACANT SITE FEES VALUATION FEE r <br /> BUILDING s 'J 0 <br /> ."A TX CONIS AIIOWANI TYPI M LDNSI ALAN, me~• wI n IrA)I IF;lnlb <br /> 111i V —K) SC_3 t( PLUMBING J I <br /> Fi I <br /> ;1I C'BIDOF i NO OF STORIES BASEMENT MECHANICAL <br /> L <br /> (4 S Sr A 2 n)o - <br /> .-UPANCY LOAD FIRE SPRNKI P AS REO D HEIGHT LLMI�ION ADDI110NAl PUN CHECK <br /> ZO1 11 <br /> N/A NG OTHER _------ <br /> REASON FOA SPRINKLI AS <br /> STATE BUILDING SURCHARGE �5O <br /> ' INTAKE BY rLANSAmfKZVEDBY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> `�I� TAX CODE IS 3105 TOTAL 7_1 <br />