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I <br /> APPLICATICA FOR CONSTRUCT6jN PERMIT everett <br /> Tha EvPFprPon TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everett HEATING SYSTEM: U OAS U ELECTRIC k1 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I I DEMOLITION f I COMBINATION I I BUILDING I ; MECHANICAL I !PLUMBING I I SIGN <br /> OWNER MAIL ADDRESS CITY IIP PN(,NE <br /> 63E5fa tc� <br /> or= nn l )0!2 Clll --AZF , Z-21/ s� se were,/ Ja .2s 7. 7A IL <br /> TENANT AILA ESS CITY ZIP PITON <br /> Y T <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP <br /> All 11c' <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY +iP PHONE LICENSE A <br /> A41PIP— <br /> MECHANICAL CONTRACTOR MAX ADDRESS CITY 21P PHONE LICENSER <br /> ITGR !J/ <br /> PLUMBING CdJTRACIOfl MAIL ADDRESS CITY DP PHONE LICENSER <br /> /✓e) a P/ <br /> I <br /> CLASS OF WORK _ <br /> I I NEW ❑ ADDITION I I ALTERATION I L/REPAIR f DEMOLITION I WOODSTOVE/FRPL INSERT GI BUILDING RELOCATION <br /> �A COHT1ACT PERSON AND P.rE NO <br /> aa <br /> CONTRACT PRICE OF WORK ✓V .Y,A ✓I /'� 33 7 7�. <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br /> iLbt)Lt+ <br /> PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS .1 <br /> ct _ 'k—e-S c l p e- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL i <br /> LEGAL DESCRIPTION OF PROPERTY ESHOWNFSEtCWOR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR i <br /> LOTBLOCK WG• OF P) 0(.I NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 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 PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTFIACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNAT IRE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> AP <br /> PROJECT ADDRESS <br /> iil <br /> CC e 17f .Z�2 APPLICANTS CITY BUSMESSI LE S NO AND BU61NE66 NAME <br /> PLUMBING ✓ /r J MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) I A/C—A/HNDLG UNITS—H.P. I <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M I I' <br /> SHOWER ' CLOTHES DRYERS f <br /> KITCHEN SINK 6 DISP i VENTILATION FAN i f <br /> DISHWASHER <br /> I RANGE HOOD ' E <br /> _ LAUNDRY TRAY ) WATER HEATER ' <br /> CLOTHES WASHER I WOOD STOVE ' <br /> _ URINAL ' METAL FIREPLACE 8 CHIMNEY ' ) <br /> DRINKING FOUNTAIN 1 FIREPLACE INSERT i <br /> FLOOR DRAIN <br /> 1 HEAT PUMP ! <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> _ ROOF DRAINS-RAINLEADERS ' EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) ' <br /> I <br /> I ' <br /> 1 ' <br /> I <br /> I ' <br /> I ' <br /> SUB TOTAL E I SUB TOTAL $ <br /> PERMIT $ PERMIT $ I <br /> TOTAL FEE $ TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PI AN CHECK NUMBER FEE RECEIPT NO <br /> I <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> BUILDING <br /> TYPE OF CONTS AIIDWAIIIE TYPE OF CONST ACTUAL otclwtr No aO'qunp UlnF ' <br /> PLUMBING <br /> SIZE OF BLDG NO OF STORIES BASEMENT MECHANICAL <br /> OCCUPANCY LOAD FIRE SPRNNIERSREO'D IIEKLIIT lIM1TATION ADDITIONAL PLA CCHECK I <br /> I <br /> OTHER <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE <br /> I <br /> INTAKE BY PLANS APPROVED BY CITY OF EYERETT PUBLIC WORKS <br /> LOCAL SALES L 5O <br /> TAX CODE IS 3105 TOTAL <br />