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APPLICATIk,A FOR CONSTRUCI .aN PERMIT <br /> OverMt <br /> crtvoFneo CITY OF EVERETT•... e <br /> everett Public Works Dept. <br /> BUILDING DEPARTM514T TO BE COMPLETED IN INK-PLEASE PRINT <br /> 259.8810 / <br /> I I DEMOLITION i I COMBINATION BUILDING �-MECHANICAL I I PLUMBING Cl SIGN <br /> 1 MAB ADDRE68 —_.._Im 1 PHONE <br /> +' D � �tilcrte-6 9kF,103 3y7-179) 3N8-319 <br /> m / <br /> .CI(Y_f t' 4LLUt%lI 9�Q <br /> TENANT MAB AODPHONE CITY 2M <br /> q C <br /> Y H REBS CITY ZIP PHONE <br /> fA ARC81ECTOROEBgNER MAB AOD - <br /> t Z <br /> CITY IIP PHONE IICEN9EA F7 GENERAL CONTRACTOR MAB ADDRESS <br /> O Q O P 5 (�/+�/7 A)1 Q/� �] SICE .T... I. .. <br /> y I�-I 1/�IIANICA CO 1TRAC 11 MAB 1/nDCII ,Ir�"� VVIP � P�- ICE BE E:::•,:V LI 'I•I�Ii J:' <br /> PIPHONE <br /> UMSWO CONTRACT MAB ADDRESS 1 CITY TIP <br /> Ox n o <br /> P' R CLASS OF VIONN <br /> [ 1 NEW I I ADDITION I LTERATION I I REPAIR I I DEMOLITION I I WODDSTOVEIFRPL INSERT [ 1 BUILDING RELOCA 10 I <br /> w ! <br /> H 1ENANTRAPRO&MENTORq/ER 'TODEL Y CDNiACi PERSON AND 01141E N0, <br /> w y /1Ml GE <br /> UI CCNIRACT PRICE OF WORK: <br /> O .71BE AND WINE FOOTAGE MVOL <br /> raPGseD ore DBa I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 0 v APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IFRAI DESCRIPTION OF PROPERTY IBNONN BELOW OR ATTACH TOUR COPIEBI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> IGT mak OF VE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVI6 ONS RANTING OF A PERMIT DOES NOT PRESUME F ANY <br /> 1X# 7b10-c0o_bi 2Q 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 /> ---- - CONTRACTORS LAW 18.27 RCW AND 288.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT LIGcpD37a <br /> x S(.U•L 0, <br /> PROJ[Ct AADO `BD �9 ^7� `�� APnICANiscttr euslN LICENSE NO AND BUS,I NAME <br /> i� IJ/ <br /> '+ PLUMBING r MECHANICAL <br /> �I NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET I AIC-AIHNDLG UNITS-H.P. <br /> ' BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> QEF LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M ' <br /> L <br /> SHOWER CLOTHES DRYERS <br /> I I ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN I <br /> DISHWASHER ' RANGE HOOD - <br /> LAUNDRY TRAY ' WATER HEATER <br /> Ina CLOTHES WASHER I WOOD STOVE ' <br /> METAL FIREPLACE 8 CHIMNEY <br /> URINAL ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ' <br /> FLOOR DRAIN ' HEAT PUMP I <br /> 1 BACKFLOW PREVENTERS OAS PIPING <br /> ROOF DRAIN S-RAINLEADERS -�_ EXHAUST FAN ' <br /> SINK 6ERVICE-BAR,ETC•) <br /> i <br /> I i <br /> -- i <br /> SUBTOTAL S __ SUB TOIAL f ' <br /> PERMIT S PERMIT f IO <br /> TOTALFEE S <br /> TOTALFEE f ' <br /> FRONT SF TBACk R[M BETBAGk BIOS SETBACK PIAN CNFCK IIIIMHI II FFE <br /> RECEIPT NO. <br /> USE IMF LOT AREA VACANT SITE FEES VALUATION FEE <br /> [ I YES I 1 NOBUILDING <br /> TYPE 01 CDO1 WOMBLE TY%nTRUST AS1uAt AA wOMIIAR UMn - - ---_ <br /> PLUMBING <br /> SIZE OF SI DO Iq OFBTORBS EMMERT MECIIANICAL <br /> 11 YES 1 1 NO I <br /> OTHER <br /> OCCUPANCY'LOAO FIRE BPRMERSRF.GD HEIGHTLAATMkIN _. <br /> [ I YES 1 I NO STATE BUILDING SURCHARGE i <br /> 11FASONFORSPRIIKLER6 ' <br /> STATE ENERGY SURCHARGE <br /> I <br /> APPLICATION ACC BY PLANS APPBOVFD GY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES le <br /> TAX CODE IS 3105 TOTAL <br />