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F. APPLICATION. FOR CONSTRUCTI,.N PERMIT <br />EtEmp'e,R TO BE COMPLETED IN INK —PLEASE PRINT <br />Cm nr <br />everett l HEATING SYSTEM: klIIGAS ❑ ELECTRIC J <br />BUILDING DEPARTMENT <br />259.8810 <br />1 DEMOLITION COMBINATION (BUILDING JCMECHANICAL xPLUMBING SIGN <br />.-O7W�NER MAIL AM-" city ZIP PHONE <br />Y U Ltd vd 132414- t�.1IlLE ' IT, S\ AlJ4 I� i 0a LY 82-1 LitS CITY ZIP PHONE <br />9 H CG <br />H M <br />He n <br />H �1 <br />oxo <br />CJ1 H <br />O <br />OH <br />z H 3 <br />9 H3z <br />[ HH <br />H <br />CgCn Cy En <br />M�M <br />ZZH O N <br />ARCHITECT OR DESIGNER MAIL ADDRESS CRY ZIP HONE <br />GENERALCONTRACTOR WR ADDRESS CR" ZIP PHONE LICENSE IT <br />AXUPe UTI.j Twt. L37, 2, 0k_wL KLs.1 1 "d 97.1 L{lSL AZIAKILE!L IZ8 III <br />MECWNK:M CONTRA( TO% MAA ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSER <br />'i4T'_tt'R1.a ?lug\L :NA 3oG14 iL. gR.• N�., ST�Ln l.Iwed '1 8Z°l2 L,52 L 521 iniTElt P R NS U� <br />CLASSCFWORK Ci <br />NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO <br />I <br />DESCRIBE WORK AND SOUAAE FOOTAGE INVOLVED <br />ll b S <br />_ <br />PROPOSED USE OF BUILDING <br />N t <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 WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CON STRIUCT ON OR THE <br />PERFORMANCE OF CONSTRUCTION. -HAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUREOFCONTRACTOR OR AUTHORIZED AGENT DATE <br />icy oSb <br />LEWSl OEN TONG PROPERTY)SO,LOW OR ATTACH�, FOUR COPIES) <br />LOT ZZ BLOCK OF dgA L ,JR. <br />u tl S k ( 0 .c -PIA S <br />��S��U� <br />PROJECT ADDRESS <br />4 <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNOLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNITHEATERS—BTU M <br />SHOWER <br />CLOTHESDRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />G <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />CLOTHES WASHER <br />500 <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK ISERVICE—BAR, ETC.) <br />I <br />T <br />SUBTOTAL $ <br />SUB TOTAL $'co <br />PERMIT s <br />_ <br />w <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: A : 11. -7 s;, <br />FRONT SETBACK <br />tar <br />REAR SETBACK <br />Z�F <br />SIDE <br />lj'K <br />/0 <br />9CHFCK ER <br />PLANFEE <br />'ZG FEE.. <br />RECEIPT NO <br />USE ZONE <br />R-'Z <br />LOT AREA <br />VACwT SITE <br />y <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />g <br />5 90i0G <br />55 i CFO <br />1YPE IXCGN15 AUDWARE <br />1 <br />TYPE a CONST ACNM <br />Y I <br />nn«Ir, Ao a oKTIIIYcwm <br />/ <br />Ti1ZEOFBLDO. <br />I j 18 a sonD <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCEIL'O.SD FIRE SPRINKLERS REO'D HEIGHTLKMTATION <br />I V A' N Z D• <br />REASON FOR SPRINKLERS <br />OTHER <br />STATE BUILDING SURCHARGE <br />50 <br />INTAKE BY <br />NIA <br />PLANS APPDDvFD By PITY OF EVERETT <br />jL y� LOCAL £4LES <br />.�So TAX CODE IS 3105 <br />PUBLIC WORKS <br />Z <br />TOTAL <br />75 : 50 <br />r <br />