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APPLICATION 'OR CONSTRUCTICA <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />G Xr5 <br />PERMIT 0,4 <br />BUILDING DEPARTMENT <br />259-8810 <br />HEATING SYSTEM: Cl GAS ❑ ELECTRIC ❑ <br />DEMOLITION CI COMBINATION IJ BUILDING `.J MECHANICAL CJ PLUMBING SIGN <br />OWNER MAIL ADDRESS PbBoy g7690 CITY ZIP PHONE <br />A <br />TENAt:T MAIL ADDRESS CITY ZIP PHONE <br />,3L5 f�V 1 o u RPfAA1L DDRESS LV 1 0"O ' Q�eU IUITYH-y ,f;Et� 1.�f4 �t SZD3 355-I 2G`1 <br />CIZIP PHONE <br />ARCHITECT OR DESIGNERS _ <br />y1GUl�J Y /J„I�V <br />N:i b\FU11\Yd«V'T" <br />JV <br />.7UV1�LV1 <br />Eel (G.K. <br />"'1 U33 <br />O V - / <br />GENERAL CONTRACTOR <br />MAIL ADDPESS <br />CITY <br />ZIP <br />PHONE <br />B7ATELIDENBE# <br />LSINDS c Mitam <br />3p)241'12 <br />SM46 <br />st EUE�>✓� <br />uJ� �Szol <br />25a1 <br />»7 LV-uu sc sJsA lw <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATd LICENSE# <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE <br />CLASS OF WORK <br />I I NEW ❑ ADDITION iVJ ALTERATION REPAIR I 1 DEMOLITION i I WOODSTOVE/FRPL INSERT i BUILDING RELOCATION <br />Ccn <br />CONTRACT PRICE OF WORK I �J�J <br />CONTACT PERSON AND PHONE NO. 9132 <br />( p <br />` )O'y ��\ rn j�1 J5�- 1 1 3 p <br />DPLSCRIBE WORK AND SQUARE FUOTAGt INVOLVED <br />1 ::T: oN I H L-lZ <br />qSq-9671 rrv) AL <br />PROPOSED USE OF BUILDING <br />V L 1 St <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 PROVISIONS OF ANY <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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />LEGAL DESCRIPTION OF HOWN BE LOW OR ATTACH FOUR COPIES) <br />ROPERTY)S <br />LOT BLOCK OF <br />PRO ECTADD ESS <br />J� -Ue� r�%L((//l CC] <br />[����jQ <br />E GNATURE <br />O� IATE <br />CR 'ESSLICFNSENO <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-A)HNDLG UNITS-H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />/ <br />SHOWER <br />_ <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK, & DISP <br />_ <br />; <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY z; <br />WATER HEATER <br />CLOTHES WASHER Z <br />WOOD STOVE <br />URINAL <br />; <br />METAL FIREPLACE &PHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSE5r; <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREV ERS <br />i <br />GAS PIPI <br />ROOF C?#INS AINLEADEflS <br />I <br />EXHALJST FAN <br />I <br />SINK (SER E-BAR, ETC.) <br />' <br />I <br />I <br />I <br />I <br />SUBTOTAL S <br />; <br />SUBTOTAL S <br />_ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: 516 ru v <br />FRONT SETBACK <br />.2 <br />REAR SETBACK <br />(IS 7-1 AJG <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />3G S7� <br />FEE <br />t7o1 <br />RECEIPT NO. <br />6fiss- <br />VSEZONE <br />-A <br />LOT AREA <br />VACANT SITE <br />1410 <br />FEES - <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />Jd- <br />' <br />TYPE OF CONTE. ALLOWABLE <br />ly�T <br />TYPE OF CONS?ACTUAL <br />IN <br />=UFANC <br />GNWP <br />NO OF MELUNGUNIIS <br />K( <br />NO. OF STORIES <br />BASEMEN <br />MECHANICAL <br />ADDITIONAL PLAN CHECK k <br />OCCUPANCY LOAD FIRE SPRINKLERS RED HEIGHT LIMITAI:.W <br />y <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />t� <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />