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APPLICA'i .ON FOR CONSTRUE, CION PERMIT <br /> PVPIOI( <br /> everett <br /> BUILDING DEPARTMENT TO E ECOM LETED IN INK—PLEASE PRINT <br /> 259.8810 <br /> 0 DEMOLITION COMBINATION BUILDING MECHANICAL !PLUMBING SIGN <br /> OMER �MAIL REBS CRY ZN PHONE <br /> �i�� /?✓,�1i 3lsrDry f!_= �`r.��fi' C��1>� �37/7�� <br /> H N T NANT MAILADDRESS CITY ZIP PHONE <br /> H ARCNR T DEJjTO�N,ERM1� <br /> y MA °RE58 C'TV ZIP PHONE�y <br /> H 7D L%�f !f <br /> 'il H GENERAL CONTRACTOR M411.ADDRESS CITY ZIP PHONE LICENSER <br /> Vl H <br /> MECHANIC CONTRACTOR MAR AODRE58 CITY 21P PHONE LICENSE <br /> O LL�W��11 <br /> H PLUMBINR CONTRACTOR MAIL ADDRESS CITY 21P PHONE LICENSE <br /> �ctillg <br /> V C❑❑❑] <br /> X H cu55 OF wa+K 1 <br /> NEW K ADDITION ALTERATION REPAIR DEMOLITION ! WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> •' H H TENANT IMPROVEML8UkDM <br /> ODEL ONLY bUJC piv#H Imit CONTACT PERSON AND NO <br /> C EAS CONTRACT PRICE On. I <br /> [7 y DESC IBE WORK ANNVOLVED `� �I /��lo I OK rL, ��J 33J-bUb6 <br /> "O-cdYL CSF-A io 4- (uc lY ` h WkPn p,Ai M <br /> j PROPOSED USE OF I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> HON f�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY IBNOWN BELOW OR ATTACH FOUR AA <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ,�� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT BLOCK of �'..,�.Zf</ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> 'A AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Ay �� '� ,�� �A OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> CJ� PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> AOWNER 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 295.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> ,rizl X <br /> PROJECT ADDRESSY <br /> tICANTB GItt BIISAlESSL N NO.AND BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AIHNDLG UNITS—H.P. ' <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> 1 LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> �+ SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 6 DISP VENTILATION FAN <br /> I <,ISHWASHER RANGE H000 <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE ) <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT I <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) <br /> , <br /> SUB TOTALS SUB TOTAL $ ' <br /> PERMIT f I PERMIT $ <br /> �'_1 TOTALFEE $ ' TOTALFEE 5 <br /> 1 FRONT SETBACK REAR SETBACK' SIDE SETBACK KAN CHE NUMBER FEE �� JCj RECEIPT NO <br /> q� L' <br /> USE ZONE LOT AREA VACANT SITE J / FEE8 VALUATION FEE <br /> TYR� I YES NO BUILDING 17k gL47 <br /> ALLDWARE TYPE IX CONST ACTUAL O[[uNA[r AOOBMUAA UnI , <br /> PLUMBING <br /> v v ' <br /> , <br /> SIZE OF BLDO p 1 NO OF STanIES BASEMENT MECHANICAL ' <br /> 31- YES x NO <br /> OTHER <br /> OCCU YLOAD FIRE SPAS REOD u[KiNT LIMITAIKNI <br /> B a:27 <br /> YES X NO STATE BUILDING SURCHARGE 5 <br /> REASON FOR SPRINKLERS <br /> STATE ENERGY SURCHARGE � <br /> APPLICATION ACC BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS i A <br /> y� LOCAL SALES <br /> 1 E�►I TAX CODE IS 3105 TOTAL <br /> ?pc/�7?' IWiv�.rGAiuF_rNoJNirrrc- , �=c�Ti¢«C <br />