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��ryny� <br />A�x <br />9 H CAA <br />H H <br />x N H <br />[* O 0 <br />OHH <br />OY C7 <br />zy��HH <br />8CA <br />H <br />dy EliE3OTA <br />C3. <br />IQ <br />IQ <br />,—A <br />APPLICATION FOR CONSTRUCTION PERMIT PYefea <br />TO BE COMPLETED IN INK —PLEASE PRINT F <br />Rre F"'j;Ynrtn <br />CITY or everett <br />HEATING SYSTEM: <br />QAS <br />❑ELECTRIC <br />❑ <br />BUILDING DEPARTMENT <br />2.59.8810 <br />DEMOLITION COMBINATION <br />BUILDING <br />MECHANICAL PLUMBING SIGN <br />O/IWIE�R MA0. ADORE 55 —� <br />CITY <br />SW <br />PHONE <br />� - ` I�'I ��IC <br />(�YIoof'CIo 'W �I)STENANT <br />ff A <br />' —jamL (040\-`AAYLLclp") Oki <br />CITY <br />.5Qw11:g <br />21P <br />98)08 <br />PHONF r1 y.\ Ul <br />emu% 7iP!-QZ�Z 1'^LcK <br />ARCHITECT Oft 7NER MA0. ADDRESS <br />(Ci <br />CITY <br />&A' <br />ZIP <br />q'irGo1 <br />PHONE <br />ceb 7.52-2I�3 <br />h�Ic�f11,00 Z8)Z <br />OENERALCONTRACTOR WE ADDRESS <br />CI <br />ZIP <br />PHONE LICENSE <br />555S-)ea2 <br />�K-5 � 1� elAd5 u)eq <br />tt)cl <br />2bc)3(c <br />MEGEANC.AL CONTRACTOR MA0. ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />PLUMBING CONTRACTOR MAL ADDRESS <br />CITY <br />ZM <br />PHONE LICENSE <br />CLASS OF WORK A�IW'W \1'�)/�\%GY•�'v'r <br />n Ncw I 1 AnnITInN .1AALTBTATION REPAIR DEMOLITION <br />WOODSTOVE/FRPL INSERT :_ BUILDING RELOCATION <br />CONTACT PERSON AND P NO <br />_ <br />L CJO' <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />PROPOSED, aevlLoeaI�1�1 <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />I i l AC 1 N G. `IV I "TAL FA 61( C !b VLNYl.i <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTKIN OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIESI <br />Lor/ BLOCK OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOr PRESUME TO GIVE <br />n \ <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />'IEGULATING <br />Lail w <br />OTHER STATE OR LOCAL LAY. CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />1 ( !)G (� l <br />�'a egg <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />Ci <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />A <br />� <br />SIGN EO CONTACC UTNORIZED AGENT DATE�,�, <br />111 <br />0— W1K <br />.1 <br />i <br />rRaecr ADDF�Ess <br />L <br />'ley'�-�75 <br />1[Jf�/ <br />ESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />,A'C AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />; <br />_ <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />i <br />_ <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL <br />S <br />; <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />f 31TT�l 3 3iIT i 1 L:T 3�1 ! I \'C <br />FRONT SETBACK <br />REAR SE.T CN 0 <br />)cism?n1 <br />SIDE SETBACK <br />PLANCHEC UMBER <br />FEE / <br />(04 (t' <br />RECEIPT NO <br />a. <br />,e.E ZONE /�jF) <br />�/P E <br />LOT AREA <br />VACANTT SITE <br />;E/ O <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />PLUMBING <br />_ <br />TYPE OF OMITS ALLOWABLE <br />•� gCON.51 AL1Uit <br />_P <br />Aowm_Lj, ALMnIL <br />SQEO4B _r. <br />IB 5 <br />NO OFSTORIES <br />Z <br />BASEMENT <br />NO <br />MECHANICAL <br />I <br />i <br />' <br />' <br />T <br />ADDITIONAL PLAN CHECK <br />rc.CUP YLGAD FIRE SPRWLERS REGO HEIOHTLIIAITATION <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING EURCHAROE <br />'I TAKE BY <br />inn <br />I 1 r <br />PLANS APPROVED BY <br />z' <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE 18 3105 <br />PUBLIC WORKS <br />TOTAL <br />f� <br />