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we <br />F i Iril <br />APPLICATION. FOR CONSTRUCTIiiN PERMIT <br />and c.+�RTN«•� <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />C TY OF <br />everett HEATING SYSTEM J GAS ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAR ADDRESS <br />TENANT AIAIL AIIONESS CITY ZIP PHONE <br />S ANE <br />ARCHITECT OR DESIGNER MAR ADDRESS/j A31 el_p JJUn• CITY 11P PHONE ('�YC11 T� �3 $� <br />.. ._�� .... .. ..•J-YJ A_ . .. o//n rinN L�H 9sayo 6'c93o.f'/�c. J <br />C F-1 <br />YHln <br />tH 0 <br />HH� <br />�M"Vd <br />tv <br />�p 8 <br />yy0. n <br />t' H <br />H H <br />y <br />2ca <br />1 <br />-EftJ1 <br />�• •.•"_ _ CITY ZIP rvnK ......." <br />GENERAL CONTRACTOR MAIL ADDRESS <br />FUE$'�7(BLUs d%ok ECl/ER6-r7C-cV 1!,fX ERETT %3'�Oj • ,5 3 %/6NE/ EI}FR- al,ml PH <br />LICENSE I <br />MECHANICAL CONTRACTOR MAR ADDRESS <br />PLUMBING CONTRACTOR MAR ADDRESS <br />CITY ZIP PHONE LICENSEE <br />wnnnaTnuctrAm INRFRT BUILDING RELOCATION <br />NEW 0 ADDITION RLICMNnu- ----'"--- <br />_ <br />CONTACT PERSON AND PHONE NO y•�� .�- 3 n S �. <br />�7llnnNp° <br />ire > Gti' <br />CONTRACT PRICE O WORM <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />�K %E71/p E'o y)( 110D 0AlervLL QA714 RhI <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PRoPm,,ousr GEBuUDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />COP /eo " 11 rN <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LE GAL DESCRIPTION OF PROPS RTY ISNOWN BELOW OR ATTACH FOUR <br />0 oco A/•vEji� QROIU I A/;J <br />pr'.r1 -LIEN <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />toT BLOCK DP <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />M I DI AV b GAk c"6 <br />AUTHORITY TO <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 />C IT Y O /- E✓,EAE T T, WA / <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC <br />SIGNATURE O CONTRACTOR OR AUTNOREED WENT DATE <br />ITy �3r3 <br />6Ug—�Srl 5-� Sj1FA_rrr LUA— <br />XSNt�NG/EISNe <br />P!. A A�My/ M1l N6- <br />PROJECT ADDRESS <br />_GUAGArJEl2 <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />FED <br />MECHANICAL <br />NO ES UIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A'C-AMNDLGEIOF <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS-B.T.U, M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I ' <br />UNIT HEATERS-B T.U. M I1300 IU Ti <br />SHOWER <br />,� '- <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />WATER HEATER <br />WOOD STOVE <br />ME1AL FIREPLACE 6 CHIMNEY <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />I <br />r" <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR. ETC.) <br />' <br />N <br />SUB TOTAL 5 <br />SUB TOTAL $ <br />- <br />PERMIT $ <br />-'r' <br />PERMIT 5 <br />TOTALFEE $ <br />' <br />5 <br />TOTAL FEE $ <br />-7' <br />FOR OFFICE USE <br />IIONT SETBACK <br />VNEa: <br />BEAR BETBAtIt <br />SIDE SET CK <br />CHECK NUMBER IE` <br />RwEIPT NO <br />�� <br />S� <br />a737s-6 y3s' <br />S3ISE <br />zON <br />LOT AREA <br />VACANT•SI� <br />FEE9 <br />FEE <br />!MEINQ <br />dVALUATION <br />DING <br />`I' 8-%'iiTYPE <br />M CONIS AtLMABI F <br />IYPF lost ACTUAL <br />- <br />3 <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />195 Sf ADDAJ <br />No <br />ADDITIONAL PUN CHECK <br />-' - <br />t)CCUPANCV LOAD <br />FIRE SPRINKLERS RE OD <br />NEIOHTLKAITAT� <br />_ <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />- I'-- <br />IHTAME BV <br />PIANSAPP DBY <br />CITY OF EVERETT <br />/ <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/j ,• <br />j q 1 <br />