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, , T APPLICATIQJ FOR CONSTRUCTION PERMIT 4:77 <br /> TO BE CuMPLETED IN BLACK INK—PLEASE PRIM 1 <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION 0 COMBINATION . -BUILDING ❑MECHANICAL PLUMBING El SIGN <br /> OWNER MAIL ADDRESS CITY ZIP p p1,A11c� <br /> lJlA.7e r.,k- Lo01'4' d."y,43,0'c 4%41,9 ,�ve.ia/f f •••-')S YY7.7 <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT CR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> 4S.vo.4.1,TrA/eau..- &/dent // .77 a9'4 Arie .SG'. tv€--'e �9FAaF 367./73 2_ S,ua,,ya#/21- <br /> GENERAL CONTRACTOR MAR ADDRESS CITY ZIP ' PHONE STATE LICENSE. <br /> /z-/43 <br /> MECHANICAL.CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE. <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZiP PHONE STATE LICENSE II <br /> CONTRACT PRICE OF WORK <br /> • el'/ OPE D <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> 7 ;RC.le$E K'%A,v - /`�? Ti j,�o.Ir,,G/0.77- /229x-T T/POss/)7�'� 337-/7SL <br /> / _ y s dy7/ <br /> 4,1' r P!,e.r./{ewil,M 4.R K ri_k-A f1;471/ rtr, I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING _ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> //ew MysQ, -,c. /.?�+.,. /P PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN OW OR ATTACH TWO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT Q a BLOCK y/ of UI Au//f 4 Aoki: /E NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> o3dd AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> A'Cvii.e.H OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> o�,�_ace, o yJ-O 20/ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 6 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> GQc�` �' tyyl'DjW APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER F CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> G v6.z-Odv-Dy1-U5•> <br /> CONSTRUCTION LOAN LENDER.ADDRESS,TELEPHONE NUMBER <br /> PROJECT ADORE X��Q 1`� '"' 9-.2 o- "L? <br /> /J�T /D �/ //�� ff{� I,,/1 SGNATURE DATE <br /> 220 116/r>7p,r/ Y/II[L.t •/ CITY BUSNESS LKENSE NO. <br /> PLUMBING ! / MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C-AMNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. 'M E.A. <br /> LAVATORY(WASH BASIN) i UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> •/ DISHWASHER I RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL I METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS I VACEEMIZ <br /> SINK(SERVICE-BAR,ETC.) . <br /> SUB TOTAL $ de ; SUB TOTAL $ , <br /> PERMIT $ PERMIT $ <br /> - <br /> TOTAL FEE $ / TOTAL FEE $ <br /> FOR OFFICE USE ONLY: 4/2/_Fair <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHCK NUMBER FEE RECEIPT NO <br /> 47gr --'f(- <br /> USE ZONE LOT AREA VACANT SITE , FEES VALUATION FEE <br /> ❑ YES' h NO BUILDING 110P- <br /> rtri OFC-O�NSLN NO.OF STORIES. NOamemmUNRS <br /> .µme.! , / ��6` PLUMBING f 1 <br /> • <br /> SIZE OF BLDG. FIRE SPRINKLERS RE OAAA_SSSEMENT MECHANICAL /..5- <br /> 313/4X T.1. No O YES .Ki NO <br /> OCCUPANCY LOAD <br /> LOAD FIRE ECG HEIGHT UMITATK)N ADDITIONAL PLAN CHECK <br /> 4 0 OTHER <br /> REASON <br /> / STATE BUILDING SURCHAR 3E <br /> INTAKE BY /— •.) EO BY CITY OF EVERETT PUBLIC WORKS <br /> ;'M LOCAL SALES <br /> 3 41 TAX CODE IS 3105 TOTAL /2l - <br /> r <br /> / <br />