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APPLICATION FOR CONSTRUCTIN PERMIT <br /> S!,4TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> 4108!_af— <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS LI U ELECTRIC <br /> 259-8810 <br /> :; DEMOLITION x COMBINATION A7 BUILDING I l MECHANICAL :L%PLUMBING FI SIGN <br /> OWNER MAIL ADDRESS ,,// CITY r ZIP PHONE <br /> /mil JPa&AAI c /Q AAA O�"����/hiasG /.. .,,✓ Z--;., l/� <br /> TENANT 0 MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> f .cr /17.77 t A.�r SIC �x�_ �7� S/ '- P!,'i)- <br /> ',. GENERAL CONTRACTOR MAIL R SS CITY ZIP PHONE STATE LICENSEE <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE$ <br /> CONTRACT PRICE OF WORK <br /> 403 AP <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED/ CONTAC}T�JPERSONy AND PHONE NO /(' <br /> 4,.. a s, -747-4 o s.,L Q.r-:/4.ri3 � 4iYea 5. <br /> !s/iD�.4 . ��.... e c+ o I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE Of BUILDING re, pr0z/d-f ¢C ,VEIL T i APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> %o e PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCRIPTION PROPERTYISHOWNBELOWORATTACHTWOCOPIESI 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 WAG, <br /> CONSTRUCTION LOAN LENDER.ADDRESS.TELEPHONE NUMBER <br /> XC'-"/71°70.1."°-3,-.-_ //-1 ..5-r-1.3 <br /> PROJECTADOREA 1 - //�f/1� SIGNATUPC DATE <br /> 27 0 ")/fr / J AA- t,"L' CRY BUSACSS LDII F:Si.,0 <br /> PLUMBING j MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC-A/HNDLG UNITS-HR. <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 /> z> SINK(SERVICE-BAR,ETC,) <br /> SUB TOTAL $ / I SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PIAN CHECK NUMBER FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION _ FEE c L <br /> YES 'I NO BUILDING;_ <br /> WE <br /> TYPE 01 COAST. NO OF STORIES mammy ASDIIrvrtilN.N:',t3 "'-" - _ a <br /> PAP PLUMBING <br /> SIZE OF SLOG FIRE SPRINKLERS REDO BASEMENT MECHANICAL <br /> 7.2 YES .. NO — (�q4 <br /> OCCUPANCY LOAD FIRE ALARM TIED I) HEIGHT LIMITATION ADDITIONAL PLAN CHECK -/).------- <br /> Tf <br /> OTHER <br /> REASON �- �" , a <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBI.IC WORKS <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL <br />