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A4 <br /> APPLICATItoN FOR CONSTRUCT mON PERMiIT <br /> EwerLtl - <br /> CNP EIrgR>oR <br /> C1 Ty Or <br /> everett <br /> BUILDINGDEPARTMENT <br /> zss-eB10TO RE COMPLETED IN INK—PLEASE PRINT <br /> 10 <br /> DEMOLITION COMBINATION _—BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAIL AD 49 CITY ZIP PN(WE <br /> �F7- oR0- 76� STSCt� gamxg-rr 9gao3 �ZS3-Dy6`f — <br /> NANT MAIL ADDRESS CITY ZIP PHONE -- <br /> r <br /> xARCHITECT OR MS'ONER MAIL ADDRESS CITY ZIP PHONE <br /> 9 I-3 Cd <br /> H GENERAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE AT <br /> H ISH 07+Y'Aa..6v <br /> MI:CNWICAL CONTRACTOR MAILADDRESS CITY IIP PHONE LICENSE <br /> OH O <br /> WPILAMNG CONTflACTOfi MAR ADDRESS CRY 21P PHONE LICENSE AT <br /> CE' <br /> O 9 uA<soFworm <br /> L NEW I 1 ADDITION ALTERATION REPAIR DEMOLITION ! 1 WOODSTOVEIFRPL INSERT l_! BUILDING RELOCATION <br /> C] <br /> 0. TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CONTACT PERSON AND PHONE NO <br /> 0 <br /> n CONTRACT PRICE OF WORK: RTHUR w 7.4,-r ,5"3 OV69 <br /> N <br /> 'y', H � DESCRIBE WORK AND <br /> y/BOIIARE FOOTAGE IN/VLOIVEO..//rr!!// <br /> ETH Asa �' /Jr (l� //YOti1 — — <br /> �y F4 H PROPOSEOUSE OF BUILDING I HEREB Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> O N H S•r-A,. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> t7 Eyti LEGAL DESCRIPTION OF PROPERTY(SHOWN 9ELMoit"CH Foun CGPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> [Q� WORK WILL RE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> !�r+� LorBI.ICK OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> y t/7 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> H O EA OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFIM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> SIGNATURE OF CONTRACTOR O/RR AIITHORIZED AGENT DATE <br /> PROTECT ADDRESS T—F • _ � �— <br /> O ^ 6 u r� A TS CRY BUSINESS LIC SE NO XD USINESS NAME <br /> _ PLUMBING MECHANICAL <br /> L�� NO. TYPE OF FIXTURE OR REM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AHNDLG UNITS—H.P. I <br /> BATHTUB __ FORCED AIR SYSTEMS—BTU. IA E.A. ! <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS ! <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER ' <br /> I CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP i K <br /> 9ACKFLOW PREVENTERS i GAS PIPING <br /> 1s' ROOF DRAINS—RAINLEADERS I EXHAUST FAN N <br /> SINK(SERVICE—BAR,ETC.) <br /> I <br /> (w I <br /> I <br /> SUB TOTAL f SUB TOTAL f ' <br /> w PERMIT f PERMIT f <br /> ISI TOTAL FEE f TOTAL FEE f <br /> FRONT SETBACK REAR SETBACK SITE SETBACK PUN CHECK NUMBER FEE RECEIPT NO <br /> USE ZONE LOTAPEA VACANT SITE FEES VALUATION FEE <br /> YES NO BUILDING <br /> TYPE OI CONST MIDWARE TYPE Of CONST ACTUAL rctuwMr AB pPNDUN,uAas — -- <br /> cnRlr PLUMBING ' <br /> SIZE OF BLDG NO OF STORIES BASEMENT MECHANICAL <br /> YES NO -- — <br /> OCCUPANCYLOAD FIRE SPRINKLERS REGD HEIGHTLIMITATION OTHER <br /> YES NO I STATE BUILDING SURCHARGE , O <br /> REASON FOR SPRINK_ERS <br /> STATE ENERGY SURCHARGE i <br /> APPLICATKANACC.BY PLANS APPROVED BY CITY OF EVER ETT PUBLIC WORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL S U <br /> V ' <br /> 5 <br />