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APPLICATION <br />FOR CONSTRUCTII.N <br />PERMIT L'VUFL'11 <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />"ewroPe� <br />CITY OF <br />everett <br />H o <br />HEATING <br />SYSTEM: ❑GAB D ELECTRIC D <br />BUILDING DEPARTMENT <br />p 13 <br />H E~il <br />259-8810 <br />1 1 DEMOLITION COMBINATION <br />�/ <br />BUILDING ✓MCCNANICAL <br />PLUMBING SIGN <br />OWNER MAIL ADDRESS <br />[ITV ZIP PHONE <br />k <br />7/4L°✓ Cgin/�E./s <br />�vc/2tTY 9f3"n6 <br />ai <br />TE/NANT MAILA1DHILSS <br />CITY IIP PHONE <br />'ZI � F9 <br />zCE�r^/` <br />s <br />/\� �� /� <br />ARCH1IECT OR DF.SIDANiR MAIL ADDRESS <br />Mr <br />CITY ZIP PHONE <br />I9- tziy�r <br />1LeEii <br />GENERAL CONTRACTOR &U A DRESS <br />CITY nr PHONE <br />LICENSEE <br />A/RCOCIl31 kc <br />Lsl O <br />MECHANICAL CONTRACTOR MAILADDRESS 2a.a. <br />IP PHONE <br />IL LICENSE E <br />I <br />T�� l(F,EI�' wow 3Y5^— 7BUo <br />R_-3 <br />z H <br />RtMBIN0 CON7 ACTOR MAIL ADDRESS <br />[ITV ZIP PHONE <br />LICENSEE <br />yH <br />r <br />._ <br />~ H I <br />vl0i1K <br />NEW 1 ADDITION ., ALTERATION <br />REPAIR I DEMOLITION 1 WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CA' <br />d 0 CONTACT PERSON AND PHONE NO <br />CONTRACT PRICEOFWORK 4 © q. �-� <br />/.. <br />�r�-�—i L <br />A <br />HO y <br />DESCRIBE WORK AND SOUARE FOOTA E INVOLVED <br />1L.I I <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />Lp��= �/p [cS'E <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEDAL DEBCRIPTKIN PROPERTY ISIgWN BELOW OR ATTAI.H IOC•1 COPIESI <br />LOT A e'f—. CLOCK 2 IxI23 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />T <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 />O %FY S <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/f - O <br />THOED AGENT DATE <br />S104AWRE OF CONTRACTOR d1 AUTHORIZED <br />rROJECT ADDRESS <br />I' <br />�A7" <br />APPPPPLLIDANTSCIIYBUSMEB IK:ENSE NO ANDBUSMESB NAME <br />�r <br />/�; _ OD���� •�j <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE _7-- <br />WATER CLOSET (TOILET) <br />AC—AHNDLG UNITS—H.P. <br />BATHTUB - <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SI K & DISP <br />VENTILATIC . FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE B CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR. ETC.) <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT E <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE f <br />' <br />..n nrrFne E mr ^AM v. <br />FRONT SETBACK <br />REM SETBACK <br />BIDE SETBACK <br />PLAN CHECK rA)MR1 H <br />I FC <br />HECEIPT NO <br />use ZONE <br />LOT AREA <br />vACMTBRE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />--- <br />1vPE OF CONTS AIIDWABIF <br />ITPE OF CONSI AEIUAI <br />In~ <br />MpRIRL1A4 UAR <br />F"0°" <br />PLUMBING <br />, E OF BLDD <br />NO Oi STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />( CCUPANCY LOAD <br />FIRE SPRNKLERS REOD <br />HEIGHT LIMI GTION <br />I <br />OTHER <br />REASON FOR SPRINKLERS <br />-t <br />STATE BUILDING SURCHARGE <br />MTME O� PLANSAPPIIDVEDBY <br />C[Tt OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/445 (/ V <br />