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[e0 <br />c r <br />APPLICATIGA FOR CONSTRUC?.ON PERMIT <br />everelt <br />the Ewgwn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK —PLEASE PRINT <br />259.8810 <br />DEMOLITION COMBINATION X BUILDING_ MECHANICAL PLUMBING SIC <br />: it <br />PHONE <br />owwER MAIL ADDRESS <br />.AAA <br />!�o`e� <br />355-Z34% <br />NEGiiT mPO.'Sox <br />bq� MI-1KIL <br />�-F•T <br />aP <br />PHgIE <br />TENANT MAR ADOness <br />Lily <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER MAR ADDRESS <br />CRY <br />21P <br />PIgNf <br />LILENSE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />- <br />Llry <br />ZIP <br />PHONE <br />IICENSf <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CI1V <br />ZIP <br />PHONE <br />IK:ENSE P <br />1'LCMBPICCd11RALTOR MAR ADDRESS <br />— <br />N ADDITION ALTERATION <br />MpROVEMEM OR INTjpION REMODEL ONll� <br />LOT_ BLOCK —r OF <br />i <br />REPAIR DEMOLITION WOODSTOVETFRPL INSERT BUILDING RELOCATION <br />-I n..ITD'11 CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK BE COMPLETED WITH OR <br />NOT. THELGRANTIING OF A ERMIT/DO SENOT RIESU EEREIN TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGUATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. LTHAT II AM AUTHORIZED BY THE <br />OWNER OF TOWHICH <br />APPLICATIIONI IS PROPERTY <br />MADE ANDPRFORM IE COMPLY WITTHEOH KT ER STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. �� Z-�j-O <br />SIONATORE CF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJECT ADDRESS <br />:LICANTSCITYBUSIN-� ENSENOANAlSNAME <br />PLUMBINGTYPE <br />FEE <br />Ty ENT <br />NO.DLG <br />FEE <br />NO, TYPE OF FlXTURE OR ITEM <br />UNITS—H.P. <br />WATER CLOSET (TOILET) <br />IR SYSTEMS—B.T.L', M E.A. <br />BATHTUB <br />ERS—B.T.U. M <br />FRANGEHOOD <br />LAVATORY (WASH BASIN) <br />DRYERS <br />/ SHOWER <br />ON FAN <br />KITCHEN SINK 8 DISP <br />OD <br />DISHWASHER <br />; <br />WATER HEATER <br />LAUNDRY RAY <br />WOOD STOVE <br />/ CLOTHES WASHER <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />, <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />' <br />EXHAUST FAN <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />SUBTOTAL $ <br />SUBTOTAL <br />S <br />PERMIT 8 <br />PERMIT <br />$ <br />TOTAL FEE f <br />gi co <br />TOTAL FEE <br />SETS BEArR�S�E ,BACK <br />1 <br />S <br />SIDESETBACK/EIS <br />N 6HE K NUMRTR FEEtq F Bra" <br />S '/ 3 <br />FRONT ILKX� <br />ewv s <br />0.VvALUATION <br />LOTAREA <br />VACANT SITE <br />FEES <br />FEE <br />USE <br />�,'r <br />RYES NO <br />BUILDING <br />PLUMBING <br />' <br />145; <br />TYPE OF acoxsl uLOwAeu <br />TYPE DI ram Aclua <br />IALIAAV,r pddKIIWANIiA <br />LAOIM <br />Q• <br />NO OE STORIES <br />BASEMENT <br />MECHANICAL <br />S�agLDD <br />Nj SE <br />YES K NO <br />— <br />_ o <br />OCCOPANCYLOAD <br />FIRE SPRNKLERS REDD <br />HEIGHiLM�-'— <br />OTHER <br />, 0 <br />it <br />YES K' NO <br />STATE BUILDING SURCHARGE <br />REASON FOR SPRINKLERS <br />STATE ENERGY SURCHARGE <br />PLANS APPROVED BV <br />CITY OF EVERETT <br />q� <br />PUBLIC WORKS V' <br />1 <br />AI pW ••vw .�^ RY <br />" <br />LOCAL SALES <br />IS 3185 <br />TOTAL <br />7 <br />TAX CODE <br />p <br />ww <br />I- V IC • 7LJ <br />