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oc <br />c C H <br />r x3(A <br />y x <br />K � <br />o�xo <br />f/l H <br />z <br />OH <br />NM8 <br />H <br />H <br />FH H3 <br />gy H <br />n C/� Q ( <br />1 rA <br />0 A3rA <br />c� <br />U ( l <br />cal <br />APPLICATILA FOR CONSTRUCZ.ON PERMIT <br />use r <br />CITY UI <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259-BB10 <br />DEMOLITION COMBINATION x BUILDING MECHANICAL <br />OYMER MAIL ADDRESS CRY ZIP PI <br />SAG. INVESTT'TPJI775 P 1710 evWTr WN 9�d� <br />PLUMBING <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CRY ZIP PHONE LICENSE/ <br />ZIP PHONE LICENSE F <br />PLUMBING CONTRACTOR MAILADDRESS CRY <br />11 <br />SIGN <br />CLASS OF WORN r-I mnu n wrnr'7TOVF/FRPL INSERT ❑ BUILDING RELOCATION <br />NEW I AUUI I IUN <br />" .... ..... _ ---- <br />TENANT <br />1 L4 <br />CONTACT PERSON AND PHONE NO <br />CONTMCi PRICE OF WORK: <br />�//� <br />N� <br />t411 <br />DESCRMEV k.E. GOUARE FOZTAOE VED <br />3l IMoF <br />6LAL4IA - N cOOJWO <br />• <br />— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PYP,OAPOSCDUSEOFBUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />cc PJIi <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCPIPTKXI OF P ERTY (SHOWN ELM OR AMA FOUR COPIES) <br />j' <br />[ uocK OF �tl - <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT <br />AUTHORITY TO VIOLATE CANCEL THE PROVISIONS OF ANY <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 />l <br />_ <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />SIGNATURE OFCONTRACTOROR AUTHORIZED AGENT DATE <br />X 1601 -SCOT tnlLl`L / KW I TVCL <br />PROJECT ADDRESS <br />s,e (offer of (nw QLA wfLT 8v'H'St, Tw ev&,Rf <br />APPLICANTS CITY BUSINESS OCENSF NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P. <br />I <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />BATHTUB <br />I <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK A DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />) <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />i <br />OAS PIPING <br />_ <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />I <br />L <br />I <br />' <br />I <br />I <br />� <br />I <br />' <br />SUBTOTAL <br />f <br />i <br />SUBTOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />' <br />TOTAL FEE <br />$ <br />TOTALFEE S <br />' <br />F RONT SE TBACK <br />REAR SET K <br />SIDE SE CK <br />PLANH�^ <br />C'l <br />/ <br />FE <br />I <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />�FEE <br />YES 1o( NO <br />BUILDING <br />�11 <br />I <br />� <br />TYR NCDNSI Al LQN/LBI F <br />TYPE Of CDNST ACTUAL <br />oauMKn womam AIR <br />AIX11 <br />%•V/ <br />�- N <br />t�- <br />'1 <br />PLUMBING <br />SIZE OF SLOG <br />NO.O STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />' <br />/ <br />2- <br />` YES NO <br />OTHER <br />' <br />O:CU <br />FIRE SPRMrIERSRE09 <br />HEIGHT LMITAiIG N <br />/ILOAO <br />/ f I <br />�(VES ❑ NO <br />STATE B ILDINp SURCHARGE <br />' <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />' <br />' <br />APaICArIONAccer PLANSAargpvEoar <br />OFEVERETT <br />ruBllcwoRKs <br />l <br />/f/�C_� <br />AL SALES <br />7TL <br />141w-I <br />ODE IS 3105 <br />roTAL <br />