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Ie o <br />H17 <br />MMN1 <br />80 <br />0 1-H <br />HN2188 <br />2H3' <br />H �`Laj <br />HH <br />8y <br />0 u FA <br />jm� <br />F30En <br />c� <br />A` <br />I` <br />a► <br />APPLI`,A1.bN FOR CONSTRUI� PION <br />PERMIT <br />TO BE COMPLETED IN INK --PLEASE PRINT <br />Lei <br />ME EYsrown <br />CITY OF <br />everettHEATING <br />SYSTEM Goa O ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />oJL <br />4� <br />259.8810 <br />BUILDING MECHANICAL <br />PLUMBING <br />SIGN y <br />DEMOLITION COMBINATION <br />1 <br />R <br />LW AUt MAA ADDRESS <br />OWAL <br />�S2e <br />ZIP <br />CITY PHONE <br />802 AIAr yaao y <br />.-�vr-/9rr <br />rA•6nk ryJIJYRNr <br />IFNANT MAIL ADDRESS <br />citr�rrrdN ZIP <br />EESIONNEA e. <br />•AMC OMW MAIL ADDRESS <br />ry(H ..AA�f ��� C{I+TY ZIIP� PHONE <br />4 7( % % <br />r <br />m Fro CIE <br />IflI�I� •3—L4_.l_si� <br />�O�R♦ <br />S71]LLT LJ. � • /I 7/J() <br />5 A � IGYJ.l1Z= <br />Gill E <br />LK:ENSE E� <br />GENERAL CONTRACTOR MAIL AIJMFSS <br />MECHANICAL CONTRACTOR MAM1 ADDRESS <br />O ^y % 7C ry ZIP PIKWF LICENSEE <br />9F/:� 3G y- y %tee 4 ,ENSEI <br />Jc ?vs ✓f <br />UNlY�lSitY M9K S!�'J}. <br />N _-- <br />PHONE <br />IICENSEI <br />PLUMBING CONTRACT011 MAIL ADDRESS <br />— <br />tuSHOFWEXiN <br />_- <br />WMOCTOVF/FRPI INSERT '.. BUILDING RELOCATION <br />NEW ADDITION ! ALItMAIIVIY - <br />-- --' <br />'-- <br />COfITAG T PERSON AND PHONE NO <br />fa <br />CONTRACT PRICE OF WORM <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOA LVED //' Y J <br />(/C <br />7 <br />rD <br />J J C <br />5I N v AN.L IN 61109RO <br />Q &I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE Of BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL OESCRIP K>N GF PROPERTY ISIIOVM BELOW OR ATTACH FOUR COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />AUTHORITY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF C014STRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.2DO WAC. <br />-- <br />BXKPASl6CONTRACTOR IA ROR <br />C SGneDATE <br />tr�'�e S <br />- <br />/&' <br />PNOJE.CT ADosESS _ <br />/6,ZY7 7T 6 AVt <br />AIMLICANIS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />FEE <br />MECHANICAL <br />N0. TYPE OF EQUIPMENT <br />FEE <br />NO. TYPE OF FIXTURE OR REM <br />A/C-AMNDLG UNITS-H.P. <br />' <br />WCLOSET (TOILET) <br />ATER <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />I <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />TRAY <br />WATER HEATER <br />LAUNDRY <br />CLOTHES WASHER <br />; <br />MOOD S <br />p PLACE <br />' <br />ETAL 6 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />' <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />' <br />FLOOR GRAIN <br />' <br />GAS PIPING <br />BALKFLPREVENTERS <br />OW <br />_- <br />' <br />ROOF DRAINS-RAINLEADERS <br />E%HAUSi FAN <br />SINK (SERVICE -BAR. ETC.) <br />I <br />- <br />t->Q <br />SUB TOTAL E <br />- <br />SUB TOTAL $ <br />PERMIT S <br />^ <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />TOTAL FEE S <br />FOR OFFICE USt <br />UNL.T. <br />RECEIPT NO <br />_ <br />REAR SETBACK <br />SIDE SETBACK <br />PIANCIIEC.K NUMBER <br />ElE <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />LOT AREA <br />VACANTSRE <br />BUILDING <br />TYPEDTCGNTS ALIOWASIE <br />tyM GT CGRST ACTUAL <br />rcL N.Y <br />Fn PPMUAW N�'S <br />--- <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG <br />NO Of STORIES <br />BASEMENT <br />ADDITIONAL PUN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE SPAWLERS REOD <br />HMHt LWITATION <br />i <br />OTHER <br />� <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />•TAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLICWORKS <br />LOCAL SALES <br />� j I <br />TAX CODE IS 3105 <br />TOTAL <br />