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a I5y3 c~n <br />H K 0 xC: <br />H �) <br />Ob H'C <br />V) H <br />x <br />DSO <br />OH <br />n• � <br />� q I <br />H �J <br />C] I= VVr) <br />jmy <br />H Oy <br />T�:3. <br />u <br />or <br />"'Pu <br />APPLICATION FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT r <br />LOW E NorpRARI <br />CIIYOF <br />_ <br />everett <br />HEATING SYSTEM: U GAS <br />❑ ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />i DEMOLITION <br />I I COMBINATION <br />1 I BUILDING <br />MECHANICAL PLUMBING SIGN <br />(AYNER <br />WRADORE69 <br />b/e 8PJf2�l <br />CITY <br />L4Mt MAgfi.:11e._4CZ)o <br />ZIP PHONE <br />3S& It <br />/11gTrraeAr ContT1%UC <br />TENANT <br />MAX ADU11E55 <br />CITY I <br />ZIP PININE <br />ARCINTECTORDESIGNFR <br />MAR ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAE LCNTMCTdI <br />MAR ADDRESS <br />CITY <br />.rll <br />ZIP PIKHIE LICENSEE <br />2LlAl1=Z4FZA�NNS7 - CITY--- bP PHONE LICENSEE <br />AUCNANICk CONIAACTOTI MAR ADDRESS <br />PILAIBOIGCMIRACIOR MAR ADDRESS CITY , ZIP NIONE LICENSEE <br />"""' " 1 I I .. I I ocoA10 I I nFMnuTION I I WOODSTOVEfFRPL INSERT 1 1 BUILDING RELOCATION <br />F rvcry , ......,...... ..._._......_.. <br />CONTACT KITSON AND MOORE NO <br />♦ <br />A++Et9__/Y(W Z]'4'SoPI/ ��y 9HIZ <br />CONTRACTPRICEOFWORN <br />DESCRIBE WARN AND SOUARE rOOTAGE INVOLIVED <br />Q <br />PRCWOSEO USE OF BUILDING <br />1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />G <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />P <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />DESCRIPOON OF PROPERTY ISHOWN BELOW OR ATTACN'CUM COPIES) <br />IEGM <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />E <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />( <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />..__ <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296 200 WAC, <br />SIGNATURE I* COWL RACION CNT AUIIgNIZED AGENT DATE <br />XJ�AAItR1RuSmh <br />PROIEGT AfgRESS y N <br />zli�' <br />.Sr NO AND BUSMLSS NAME <br />PLUMBING <br />MECH ICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />y <br />WATER CLOSET (TOILET) <br />IQ <br />ANC-AMNOLG UNITS lip <br />FORCED AIR SYSTEMS BTU. M E.A. <br />�- <br />BATHTUB <br />i - <br />'t <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B TH <br />SHOWER <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGE HOOD _ _ <br />_ <br />KITCHEN SINK A DISP ' <br />DISHWASHER <br />LAUNDRY TRAY <br />�- <br />WATERHEATEn <br />WOOD STOVE <br />METAL FIREPLACE 6 CHINNI Y <br />FIREPLACE INSERT _ <br />HEAT PUMP <br />GAS PIPING <br />CLOTHES WASHER <br />T <br />_1 <br />URINAL <br />' <br />_ <br />DRINKING FOUNTAIN <br />_ <br />FLOOR DRAIN <br />�— <br />_ <br />BACKFLOW PREVENTERS <br />_ <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />? <br />SINK (SERVICE -BAR, ET—.) <br />I' <br />_1 <br />I <br />� <br />tie <br />11A, ),)�A�AA•)• <br />I <br />— <br />I <br />SUB TOTAL <br />f <br />i <br />SUb IOTAL f <br />--)-- <br />--- <br />- PERMIT <br />f <br />PERMIT f <br />�— <br />TOTALFEE <br />f <br />TOTAL FEE f <br />rIKMII SETBACK <br />REARSEIBACN <br />� <br />SIDE SEIBM:X <br />PI AB'HEC. NUMBER <br />((-_`fly <br />FEE <br />RECEIPT NG <br />usE torlE <br />LOT AREA <br />:;;paoo <br />vACAHT snE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />— <br />PLUMBING <br />�j C <br />�` �_i✓� <br />JC I D� <br />ITPT IK C.MITS M IOWAN E <br />IYPF 0I CONSI MIuu <br />V - T 1 <br />EUVAA[r <br />NanRWurIEMAU <br />SIDE OF BL DU <br />NO OF STORI <br />IMSEMENT <br />AD <br />MECHANICAL <br />i <br />ADDITIONAL PLAN CHECK <br />- <br />OCCUMNCYIOAD FIRE SPRNACLEFTSMOD HCgllLOAN 11G7>ION <br />k U 4- <br />GINNER <br />_-_eI/ <br />NEAS(AI ONSPRwKLERS <br />-- <br />-r-. <br />STATE BUILDING SURCHARGE <br />_ <br />_ 'f i� <br />OIIANr BY <br />PLANS APPROVLO BY <br />CITY OF EVERETT <br />III BI IC WORKS <br />7/7 <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />5 ? w <br />S <br />