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APPLICATIO FOR CONSTRUCTIjN PERMIT 4, <br /> spa TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ]GAS LI ELECTRIC Ui 259•8810 <br /> [.I DEMOLITION )e. COMBINATION AlBUILDING [ I MECHANICAL PLUMBING Cl SIGN <br /> OWNER (/. (J�'��JS/MAIL ADDRESS �(/ CITY /-"��,,ZIIPP s/ PHONE <br /> i� 4,tG ' - .)3AD O"Y 4Ze/C ,I/!/� GZ�+€4 2 PHONE <br /> TENANT <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> A spa.,.:,yti �,.„v , f, ,4r //Z �Z? ,d.4 . . .I .�e� 5-% s �y� 0 • - <br /> C:GENERAL CONTRACTOR MAIL RESS1Jn,I CITY ZIP PHONE STATE LICENSE A <br /> -5-^'vr'74,.c4/.11 7.A' <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE■ <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br /> CONTRACT PRICE OF WORK <br /> 63AF0 <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO <br /> 5-727 ,Gc.".4,1 ee,,,W, ;A/ 5iv.4/),-i 3/4c..t ,,,0.47.4 .osS41-A 57y-'de 9/3- <br /> 4,,,.o .ss(-f;-�o..z dx!.r;J "g/Je�dy <br /> G/iD1i4 ✓.01 /��/1�7/ �j�oj I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING 7 pPOvi 1 'K'b &eV/ f APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 5"71; .C► PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCRIPTION Olt PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT- BLOCK OF 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 /> PARCEL TAX I D NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRESS.TELEPHONE NUMBER <br /> PROJECT ADORE SISMAT F Dul <br /> 270 ( K. lr'J &Ar7'U CITYBUSA LK(LSL NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) [ A/C-A'HNDLG UNITS-H.P. I <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN( UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> 1 DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> _ ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> C,Z> SINK(SERVICE-BAR,ETC.) pi <br /> SUB TOTAL $ /L./i SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $, , <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO. <br /> FEE <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION , <br /> YES r NO BUILDING C!/'J <br /> TYPE Or WEST. NO OF STORIES '''"..,v No o,M itl'+.tl,IS <br /> `S.,1:1,' PLUMBING / <br /> SIZE OF BLDG FIRE SPRINKLERS REOD BASEMENT MECHANICAL <br /> YES NO -- <br /> OCCUPANCY LOAD FIRE ALARM REOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> OTHER <br /> REASON {j/I <br /> STATE BUILDING SURCHARGE 1,/ CL <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL , <br />