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APPLICATIOR ;OR CONSTRUCTILA PERMIT <br />1"0 BE COMPLETED IN BLACK INK —PLEASE PRINT E �/rerr <br />BUILDING DEPARTMENT HEATINGSYSTEM: U GAS(ELECTRIC J <br />— <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />ER MAILADORLSS CITY ZIP PHONE <br />�. ,l/o,��e+✓ `'o c1o>I,ZzZ /'yo..-.eP� 9Y.2�i �d'�- S�9,c <br />TENANT L/ MAIL ADDRESS CITY �/J'�s ZIP( PHONEr (/ <br />A ITEGT OR OES/�'CIGNER JAIL ADDRESS � fC��LC•c ' ll f �'�O / PHONE <br />2_ _ / y� <br />Uwn!c,,P— <br />GENERAL CONTRA IOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE II <br />MECHANICALOON RA TOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSED <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />v ...,.,.,..., onnnM REPAIR OFMOI ITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />I. 1 11— oc V V' • • <br />.tr <br />CONTACT ^ RSSON AND PHONE"ujnyy�� <br />CON TRACT PRICE OF WORK 00 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CP CR, "os,e.G— ;o <br />PROPOSED,USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />4— CO CA4W < '�NG� <br />APPLICATION AND KNOW THE SAME'.0 BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDSAANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />,0/IV/IVC,' <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT.1BLOCK _ OF �/,P % e% <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />Purr <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />T?A.uFrocD <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />I►✓ Vol.. 3 o1�Q�Ts /�6 .3'-' <br />l <br />X _`�1LL.c JCw�— Y�3�z <br />_ i <br />SNe�. c <br />PROJECT ApD 'ORS <br />5.31"„,- PaII <br />^ <br />0. ( IJTF� . <br />�nvn run <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE CR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />AC—AHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK A DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />1 <br />EXHAUSTFAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />T <br />1 <br />' <br />1 <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />�— <br />TOTAL FEE $ <br />I TOTAL FEE $ <br />I' ITPC n IV <br />FRONT SETBACK <br />U87NI <br />RQ&JSJETBAC <br />LOT AREA <br />SIDE SETBACK—_ <br />VACANT SITE <br />PUN CHECK NUMBER FEE <br />FEES <br />VALUATION <br />PECE�PTNI <br />•FEE <br />PLUABING <br />— <br />I <br />TYPE OF CONTS ALLOWABLE <br />SI EOF BLOC.. - <br />TYPE OF CONST ACTUAL <br />NO.OFSI <br />Otturwxcr xo lanwIlLIWl Il <br />sBm3 <br />OABEMENT <br />MEC4ANICAL <br />SNIT /�1_ <br />N O <br />0DITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />ADOL <br />FIRE SPRINKLERS REOD <br />uo <br />NJIGNT LIMITATION <br />r'l <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />CALSALES <br />LOCAL <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />