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I , <br />APPLICATI�.! FOR CONSTRUCT��N PERMIT everett <br />rneevo�greon TO BE COMPLETED IN INK—PLEASE PRINT � <br />F <br />CTY O <br />everett � <br />; BUILDING DEPARTMENT <br />' 259•8910 <br />❑ DEMOLITION U COMBINATION <br />'. OWNER , /y MMLAODRESS <br />; ,,�%p1p�/i/c /�. �9/Gl� l �/!s e <br />� TEN�NT/ / ,� '� %� IL FDDR �S <br />.. �v,nh .....'<.S [p 1"//!!6/C/�//' �C✓/I. <br />AFCHIiEC70R0E51GNER M ILADDRE55 � <br />�/j�J���,.../"c�'iv',�����D! `� <br />� C1A550FWORN ' 9 <br />� I I NEW fl ADD�TION ih�ACfER� <br />Y <br />CONiRACT PRICE OF WOAK —% �j ,�+"j[1.�y <br />.-I DESCflIP K'OP �AND SOUp�7LE FOOIAG/E INVOL/VE[ <br />�r/�J< rf lrir7'i,�s^ <br />.j PROPOSEDUSEOFBWLOING <br />' 9�i��' D%�'�Hs <br />.I LE6ALOESCRIPTIONOFPROPERTV�SHOWNBELM <br />LOT BLOCK OF <br />i ', ,/ / <br />� � �rP/�vi of N �' <br />.� �. / <br />� �� y4�Y/i�%1 7>�� U ' <br />� �e��X �' s�BF <br />� �� ,��' �S. � �/ <br />� PRQIECTA�Df1E55 �_ <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />LI BUILDING <br />CITY <br />�_ <br />� <br />CITY <br />�5 <br />CITY <br />� <br />CI7V <br />� <br />CITY <br />y� MECHANICAL <br />ZIP PHONE <br />P� is�a0/ <br />Z�p PHONE <br />i .f <br />❑ PLUMBING ❑ SIGN <br />�- S/3.� <br />�-}p','ixrilSY3S3 (�YG' -G^/cC� <br />ZIP 1� PHONE LICENSE a <br />�'d:�0 ���s�.si7�s' � <br />Z�p PN'NG / LICESNSE� <br />�%/L'!�� % S�%� 1/ DJ'tS��J! <br />ZIP � PHONE LICENSE M <br />I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I 1 BUILDING RELOCATION <br />CON7ACT PERSON AND PIIONE NO. ' <br />COPIES) <br />N0. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHEfl <br />URINAL <br />DRINK�NG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRE�ENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE-9Aii, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />`i FOR OFFICE USE ONLY: <br />� <br />FRONT SETBACK RE�R SETBACK <br />; - <br />USE ZONE LOT AREA <br />� <br />I TYPE Of CONIS. ALLUWABLE iYPE OF WN4. ACiOAL <br />512E OF BIDG. NO.OF STOf11E5 <br />� OCCUPANCVLO�D FIfiESPRNNLERSAEO'D <br />, <br />REASON FOH SPRINKLERS <br />I <br />i <br />� INTAKE BY FLANS APPROVE� BY <br />i, --� `-^� . <br />� <br />� <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 ORDINRNCES GOVERN�NG THIS TYPE OF <br />WORK WILL BE COMPLE'TED WITH WHETHER SPEC�FIED HE�EIN OR <br />NOT. THE GRANTING C1� A PERht1T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOI.ATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR I.GCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PFOPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 18.27 RCW AND 296.20D WAC. <br />SIGYATURE COViflACTOROItAUTNGRIZEDAGENT DATE <br />x ' <br />�-.��� S-�� �r/ <br />APPLI ANTSC O1151NES5LICENSEIIO.AN�BU51NES5NAME <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE � <br />NC—AIHNDLG UNITS—H.P. � � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />UNIT HEATERS—B.T.U. M � <br />CIOTHES DRYERS ' <br />VENI'ILATION FAN � <br />RANGEHOOD ' <br />WATER HEATER � <br />WOOD STOVE � <br />METAL PIREPLACE & CHIMNEY ' <br />FIREPLACE INSERT � <br />i <br />�-T <br />HEAT PUMP ' <br />GAS PIPING _—� <br />EXHAUSTFAN ' <br />SIOESETB�CN PLANCHECKIIUMBEB <br />y/ � �%C <br />vncnr+r srte FEES <br />�UILDING <br />p(CpfANtr 110 O�VMRlING11MII5 <br />r,nnuv PLUMBING <br />Bn5E1.�ENi h1ECHANICAL <br />HEIGHi LIMITATION '� P�N CHECK <br />n <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />L�CALSALES <br />TAX COOE IS 3105 TOTAL <br />� <br />� <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FE�: $ <br />RECEIPT�70. <br />�O �e't� ' J <br />