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APPLICATION FOR CONSTRUCTION <br /> PERMIT <br /> everett <br /> BUILDING DEPARTMENT _ <br /> H 1c�y' 259.8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> H MAIL ADDRESS CITY PHONE <br /> GSH — <br /> A H E6 '[NANT MAIL ADDRESS CITY ZIP PHONE <br /> Ko1iKoKU GOLF P.R►J6>r / 1407 s sn/ <br /> e1gHHECT OR DESIGNED MAq ApDRE99 LIIY ZIP PHON[ <br /> HQ <br /> !� Ly � cCNERAI CONTRACTOR MAIL ADDRESS city ZIP PHONE LiQ.N1l�-- <br /> En H <br /> H �,." yr.CNANgAL CONIRACRIR M LADORE59 CITY IIP ONE UCENSEP <br /> o 0 1,OD�STf�R CO 7a� i�SI �%ITTLE 981?,Z 546 19�i$ P�IZ4V�' <br /> O H PLUMSINO CONiRAG10R MAIL ADORES CVY zIP Z rnUnc / LICENSE <br /> �l A$ FNORN <br /> Z H NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> TENANT IMPROVEMENT OR INTERIOR EMODEL ONLY CONTACT PERSON AND PHONE NO e <br /> LNTRAC8 �� DOS FI EIWORK MOSCUAREFDOTAOEINV ED �DMICE OF WORK � � � '��y�Q ��� <br /> ILICTA) I <br /> P�ROP�09�ED USE OF�SUARGING 1� / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br /> H yoy r^l•.fF 7,WSE nt���L SLOP KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND <br /> LEOALOE9CRIPigNIR POPEPTY I9HowN eELow OR AnALN FOUR coWES ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT THE GRANTINGOF APERMITDOES NOT <br /> PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> LOT BLOCN OF ANYOTHER STATEOR LOCAL LAW REGULATING CONSTRUCTION ORTHE PER. <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> TAX 397Z-000 - 0;:j7-000'7 THIS PROPERTY TO PERFORM THE WORK FORWHICH APPLICATION IS MADE <br /> Z y1 AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br /> 2911 O)� —000z SIGNATURE RA I RO AU H R REpAOEN1 DAZE <br /> X �6 <br /> f _ PROJECT ADpRE99 O t', n' BWI ESSL CENSE NO ANO BUSIP•99 AME <br /> I T� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> _ WATER CLOSET(TOILET) _ AIC-NHNDLO UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-STU 1,9A EA 7, <br /> I LAVATORY(WASH BASIN) UNIT HEATERS-8.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK B DISP _ VENTILATION FAN _ - <br /> CDISHWASHER RANGE HOOD _ <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHESWASHER - - - _-- - WOOD STOVE <br /> URINAL _ METAL FIREPLACE B CHIMNEY <br /> c:) DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEATPUMP <br /> BACKFLOW PREVENTERS OAS PIPING Z OUTL -- <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> coSINK(SERVICE-BAR,ETCI <br /> SUB TOTAL S _ _ _ SUB TOTAL S <br /> PERMIT S _____PERMIT <br /> c� TOTAL FEE 6 TOTAL FEE 5 <br /> FRONT SETBACK REAR SEISAD.K SIDESETBAL. PUN CHECK NUMBER IFF RECFIPTNO <br /> USEZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> 1.)YF9 ;:NO <br /> TYP Of CONST OCCUPANCY GROUP NooFDWELUNDUNHS BUILDING _ <br /> ALLO/MBLE/ACTUAL PLUMBING <br /> SIZE OF BLDG NO OF SIORIES 89M1 OCC LOAD"Y MECHANICAL <br /> NENiNi LIMIInTION OTHER <br /> FIRE SPRINKLERS REWIRED DYES n NO STATE BUILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPLICATION ACC BY PLANSAPR BY �- --- <br /> PUBLIC WORKS _ <br /> TOTAL <br />