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h <br />APPLICATIGA FOR CONSTRUC7.ON PERMIT 4 <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION xx <br />BUILDING <br />MECHANICAL <br />I ! PLUMBING SIGN <br />Oµ?1ER MAIL ADDRESS <br />3ZUO Pdt7L� <br />a CITY L <br />FuT <br />ZIP <br />�� ZD <br />PHONE <br />ZrC/ <br />CITY OF EVERETT t <br />TENANT MAR ADDRESS <br />CITY <br />ZIP <br />ONE <br />PHONE <br />PORT GARDNER PHYSICAL THERAPY <br />1701 <br />41st ST <br />SUITE A2 <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CRY <br />ZIP <br />PHONE <br />S_EATTLE WA <br />STATE LICENSER <br />98105 <br />i�1a ALKI CONSTRUCTION CO. 4731 <br />12th ave <br />n.e. <br />1'MECHAMCALCONTRACTOR MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />A� <br />STATE LICENSE <br />KI cc� l�s NR <br />PLUMBING CONTRACTOR MAR ADORESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CLASS OF WORK <br />I I NEW ADDITION XXALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT ! BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK Y a V,- <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />Demo int partition and add interior part.tions <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />P s ical Therapy Clinic <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />THIS TYPE OF <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR OOPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />I.oT12, 13, 14 BLOCK 5 OF FRIDAYS EDITION <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />15, &16 <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 />EVERETT, SNOHOMISH COUNTY ACCORDING TO <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />PLAT VOLUME 3 Of PLATS 39 <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X -/ <br />PROJECT ADDRESS <br />sI AIURe oNNF <br />3531 Rucker Ave EVERETT, WA <br />KIKS[ NO <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 />_ <br />_ <br />AC—AHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS--B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN�— <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL S <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT $ <br />TOTALFEE S <br />TOTAL FEE $ <br />u V. <br />vn vl . <br />P RONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CNECK NUMBER <br />IEE <br />RECEIPT NO. <br />LISE ZONE <br />LOTAREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />cr <br />I <br />TYPE OF CONTS. ALLOWABLE <br />AJD <br />TYPE OF WNST. ACTUAL <br />Ottuwwy <br />N mx4 unn5 <br />SIZE OF BE DO <br />NO.OF STORIES <br />kv G/,fdTtJO4E <br />BASEMENT <br />A.O <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOD FIRE SPRNIKLERS REOD HEIGHT LIMITATION <br />V <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />I <br />STATE BUILDING SURCHARGE <br />I�O <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY O EEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />2 L5_ Q <br />