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APPLUCATION FOR CONSTRUCTION PERMIT <br />ove`mlt <br />LAP Eve,preon <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK —PLEASE PRINT <br />DEMOLITION COMBINATION D( BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL AD' <br />RE64 [J CITY :(�' - PNONE/T— <br />�i �H li npl N IyA (� -U% btu 1_A7AAVu1)! I oboz ?-7%y'a•-71 7 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />i <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />LICENSE I <br />MAIL ADORFSS <br />CITY <br />ZIP <br />PHONE <br />T4r1215 l n-ISTLJGT1w <br />I4M17 eI <br />P LJ Eri <br />A Yo\NIAiA <br />CU3420 77`44.699 <br />'T4rv!!II:* UuPS <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICEN'EI <br />PLUMBING CONTRACTOR YIL ADDRESS CITY ZIP PHONE LICENSE I <br />CUSS OF WORK <br />(X NEW i_ I ADDITION ALTERATION REPAIR LI DEMOLITION WOODSTOVEIFRPL INSERT (-i BUILDING RELOCATION <br />U TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY CONTA PERSON AND PHONE NO. <br />Y�CONT('ACT PRICE OF WORK;`1\ L (� 1a U\ IHGrn PSa•.r <br />SCRATE WORK AND SOUARE FOOTAGE INVOVED <br />13 � 1� r�dFit u 146 m,15 <br />�PROPOSEDUSEOF BOIL ING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />0;1 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />T BLOCK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />EL <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 />APPLICATION IS DE AND I COMPLY WITH THE STATE <br />CONTRACTORS 1B. 7 RCW AND 296.200 WAC. <br />SIGNATURE OF CO <br />rl TOR AUTNORU'ED AGENT DATE <br />X �' , <br />PROJECTADDRESS <br />APPLICA SUSINESSLICEYNO. ANDBUSINESSNAME <br />PLUMBING o 7 MEC ANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br />Z WATER CLOSET (TOILET) A/C—AIHNDLG UNITS—H.P. <br />I BATHTUB'nit FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) UNIT 1,EATERS—B.T.U. M <br />( SHOWER !rfi CLOTHES DRYERS ' <br />KITCHEN SINK A DISP VENTILATION FAN ; <br />I DISHWASHER RANGE HOOD <br />LAUNDRY TRAY I WATER HEATER ' <br />I CLOTHES WASHER 5. nrl WOOD STOVE <br />URINAL ' I METAL FIREPLACE 8 CHIMNEY ' <br />DRINKING FOUNTAIN r FIREPLACE INSERT <br />FLOOR DRAIN HEAT PUMP ' <br />BACKFLOW PREVENTERS r i GAS PIPING <br />ROOF DRAINS—RAINLEADERS �— EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) ' <br />I <br />I <br />SUB TOTAL $ SUB TOTAL $ 4r4 no <br />PERMIT $ + PERMIT $ 1 <br />TOTAL FEE $ TOTAL FEE $ <br />FRONT SETBACK REAR SETBACIIAMy SIDE SETBCCK PLAN CHE 'L"g FEE py RECEIPT NO. <br />40 'g� '5S13 Y{L� 13 <br />USEZONE LOT AREA c VACAN SITE FEES VALUATION FEE <br />/ YES C! NO BUILDING Z <br />TYR OF CONST ALLOWABLE TYPE OF CONST ACTUAL axurMrzr AOaanulxc lAin , <br />J / PLUMBING a: on <br />r <br />SIZEZ BLQQ r NO, OF STORIES BASEMENT MECHANICAL _ �r) vTo <br />5Z '2' I I YES X NO <br />\'^ I <br />N <br />OCCUPANCY OAD FIRE SPRNKLERS REGD HEIGHT LIMITATION OTHER V K- IL I <br />I YES NO STATE BUILDING SURCHARGE I <br />REASON FOR SPRINKLE RB <br />STATE ENERGY SURCHARGE � <br />APPLICATION ACC. BY PLANS APPROVED BY CITY OF EVERM PUBLICWORKS <br />/ � LOCAL SALES <br />TAX CODE IS 3105 TOTAL 661 ;1-. <br />Sl P. tpb-b9 <br />Sl P. tpb-b9 <br />