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aH3m <br />C N M1 <br />yH <br />O� <br />O I� <br />Myy0 <br />, V ❑ <br />Cy1 <br />H �3 <br />�py W <br />0 0t~A <br />l m tat <br />Z H Tn <br />I.3 O (A <br />APPLICATION FOR CONSTRUCTIC_. PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT n <br />LAB Erergwn <br />CITY OF <br />everett <br />LHI <br />RIC U <br />BUILDING DEPARTMENT <br />259.8810 <br />�• DEMOLITION <br />BUILDING <br />MECHANICAL <br />PLUPABING SIGN <br />OWNER <br />____._COMBINATION__ <br />MAR ADDRESS --_ -� CITr, <br />ZIP PHONE <br />L� c ,fA T` <br />l," C ' x,4r4, era / L <•/ <br />F✓E. uc. 9 2e,l <br />TENANT <br />MAL ADDRESS CITY <br />IP PHDHE <br />N <br />- - <br />ARCHITECT R DESIGNER <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />%lacL� <br />•7/ <br />_ <br />CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />LICENSE III <br />��ENERAL <br /><J�•. YfIEHLlr <br />G••�i F Ifl/�' dr,ur, Ccr 4±4 F✓T `�Fky CI-77cr <br />GC• ,vYee. /9111L <br />MECHANICAL CONTRACTOR <br />MAR ADDRESS CITY <br />SIP PHONE <br />LICENSE <br />PLUTABNOCONTRACTOR <br />MAILADDRESS CITY <br />ZIP PHONE <br />LICENSEE <br />cLAc�.oF woRx <br />N' ADDITION ALTERATION REPAIR DEMOLITION <br />WOODSTOVE/FRPL INSERT .BUILDING RELOCATION <br />NEW <br />_ <br />O[. <br />7z o <br />CONTACT PERSON AND PHONE NO <br />; s 5 ����t <br />ICE O: WdN CONTRACT PR%j1,L'L'(' <br />, ✓,t <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />rt✓a.-/ F4tTt1/fwr ,.J 4E <br />S .../ !'ATa ✓1 <br />.L., 71 G ,,[T <br />•: /JPr/ <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BF LOW OR AT TACK TWIT COPIE S <br />LOT(/ 'A, . [ T BLOCK x �j<a•i.' <br />VrSt,r _ <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL -HE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULA7?10 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 />COITTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />S*NIJTE OF OR AUTHORIZED AGENT DATE !I / T <br />— <br />X 1V4 // Au eLl <br />Au <br />PROLE Ci ADDRESS <br />I <br />APPI ICANTS CIr•' BIISMFS5 LICENSF NO AND BUSINF SS NAME <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />19:[7 <br />AC —A HNDLG UNITS—H.P. <br />I <br />/ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU. M E.A. <br />' <br />2 <br />LAVATORY IWASH BASIN) <br />.� <br />UNIT HEATERS—B.T.U. M <br />I <br />SHOWER <br />CLOTHESORYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />I <br />DISHWASHER <br />/ <br />RANGE HOOD <br />LAUNDRY TRAY <br />/ <br />WATER HEATER <br />' <br />WOOD STOVE <br />CLOTHES WASHER <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />_ <br />SINK(SERVICE—BAR. ETC.) <br />' <br />I <br />I <br />b <br />, <br />SUBTOTAL <br />f <br />SUBTOTAL f <br />' <br />PERMIT <br />$ <br />—N- <br />PERMIT f <br />TOTAL FEE <br />f <br />1li I ccl <br />TOTAL FEE f <br />' <br />I NOWT SETBACK <br />PSAR SETBACK <br />SIDE SEI➢ACK <br />PLAN CHECK NUMBER FEE <br />3 D. ') <br />RECEIPT ND <br />49 <br />z Boa <br />c ZONE.LOT <br />AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />L/7 ' <br />i <br />�/ <br />e70 2� <br />..II115 MlON'ANl <br />ITPI CONST Attuu <br />auNANEr Nlnlew.uany <br />GAGP <br />�J <br />/ <br />IEJi <br />L <br />SltI. UI HLD6 <br />NO GF STORIES <br />BASEMENT <br />MECHANICAL <br />IZ 3f + <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REGD HEIGHTLIMRAI ON <br />11� I,(J <br />OTHER <br />i <br />STATE BUILDING SURCHARGE <br />is <br />ILEA-SpN ORSPRINKLERS <br />INTAKE BY <br />PLANS APPIKIVEO BY <br />CITYOFEVERETT <br />PUBLIC WORKS <br />.1 <br />Zy �yv <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />07 I dU <br />1t ` <br />5 23 <br />