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z co <br />133 O CAI <br />13 <br />APPLICATICPA FOR CONSTRUCI.JN PERMIT <br />TO BE COMPLETED IN INK—PLEA$E PRINT r —."I <br />CITY OF _ <br />everett HEATINGSYSTEM: GGAS gELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING 7Ly'-1 MECHANICAL PLUMBING SIGN <br />OWNER MARADDREBS 230G73*- OGV ee \IIWQ?IP ct 9�O -3 PRUNE 090 76 <br />SOSW , U S aft fa P2 Ei o <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARLNREC7 OR DCSIGNj'R ATAtt ADDRESS C11Y ZIP PHONE <br />LI/rEs ?7 75 rd SIT gE yEy-l"ETr 982N?3 353 4531 <br />GENERAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSER <br />r - %_ -..- <br />RC <br />MECON <br />AADDRESS <br />CITY Zip PHONE <br />LIGtRDc• <br />PLUMBING CONTRACTOR <br />MAR ADDRESS <br />CITY ZIP PHONE <br />LICENSER <br />CLASS OF WORK <br />1. <br />✓., rvnATInAI <br />GCGAIR nPMnLITION WOODSTOVEIFRPL INSERT <br />BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO 3117,20 76 <br />OWMe <br />CONTRACT PRICE OF WORK <br />CESCAME WORK AND SOUARE FOOTA/GE. IINVOLVED <br />11I g6110lt•HJ E{F O / Z-1 <br />7 5.F ( vg0T A•�44017,' >'TCA96 1"LtiM <br />faVW- <br />- S4_/Y <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />•�i •E <br />Cmi.D CAj� / I L�IY l7ooM _ <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 OCSCRIPigN D<PROPER7Y ISIOVAN BELOW OR ATTACH iWRCOPIESI <br />" E <br />LOT_ BLOCK �Z of sr Div <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE CANCEL THE PROVISIONS OF ANY <br />1l <br />OTHER STATE OR LOCAL LAW 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 />4 CONTRACTORS LAW 18 27 RCW AND M.200 WAC. <br />E <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />X4L—z3-�� <br />DG SSLMEN OANDBU WESSNAME <br />atitI,kq <br />-- <br />PROJFCT MKRIESS <br />�3p6, 751¢b ST Cjii �VEICE7T <br />PLUMBING <br />HANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A G-AHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED -AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />-�•'� <br />EXHAUST FAN <br />_ <br />SINK (SERVICE -BAR. ETC.) <br />_ <br />1 <br />•T <br />1 <br />I <br />SUB TOTAL f <br />SUB TOTAL f <br />PERMIT <br />TOTAL FEE f <br />G <br />PERMIT S <br />_ _ <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />AC <br />FRONT SETBK <br />_ <br />USE ZOI <br />` <br />__ <br />BE AB SE TEM.K <br />S Tt rJ <br />LOT A9fA <br />9DE SFiBACR <br />VACANT SITE <br />J <br />_ <br />f,:'. - '� !'MINI Z FEE <br />FEES VALUATION <br />RECEIPT NO <br />-f 9 6.2 <br />FEE <br />BUILDING <br />PLUMBING <br />T- <br />TYPE Of CONES kIDW'ANE <br />�- AI <br />TYPE OF CORSI ACIIIM <br />—.{t• N <br />OC'e <br />-3 <br />W".IMIu'M•IAVR <br />_ / <br />MECHANICAL <br />SIZE Of BLDG NO OFF SSLONES FASEMFNT <br />SF o <br />OCCUPANCY LOAD fTE RPBNKI FRS BEOO HEIGHTLIMITATKX/ <br />-7 <br />(i <br />BLASONFORSPIUNRLERS <br />ADDITIONAL LA CHECKN, <br />OTHER <br />— <br />STATE BUILDING SURCHARGE <br />IT <br />INTAKE BY <br />PLANS APPROVED SY <br />5/B <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />;6 <br />