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APPLICATIt� FOR CONSTRUCT�N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ',� GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />f 1 LIEMOLITION I! COMBINATION C BUILDING ' i MECHANICAL f PLUMBING `J SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />��1+�..r���a�o� ivor-�er� �'.ct� ��oacl Cp. �cx�o F�C.949 '3'`dAve, S�a,�-�-�e,I.c�A 98�04 ZO�-Q�7-3Zq� <br />TENANT MAIL ADDRESS C17�Y ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />GENERAL CONTRACTOR MAIL ADDRESS <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE I <br />`•� �0.ti.�i�CV�� Siq <br />1=. r. lA � O vin P �.n � � I.c t' � � <br />� <br />> � X/U � � �r� �r �n <br />CITY ZIP <br />CIIY ZIP <br />CITY ZIP <br />CITY ZIP <br />�� •�a�u-.es % <br />��e� CONTACT PERSON AND PHONE NO. <br />PHONE <br />PHONE STATE LICENSE # <br />PHONE STATE LICENSE # <br />PHONE STATE LICE!NSE # <br />o,r-aav� Zo�-�7-3Z.`l <br />�'i"'f�ai�5 � �n. '�1 �r'����-S . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE F�ND CORRECT. ALL <br />�f O 2 C � O� �O S- s� tno�� ��e C�roH: L'E t.�� � PROVISIONS OF LAWS AND ORDINANCES GOVER�IING THIS TYPE OF <br />�Eca� oEscRiPnoN oF PROPEFiTv �sHowN LOW 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 />�oT e�ocK �F AUTHORITY TO VIOLATE OR CANCEL THE PRUVISIONS OF ANY <br />�5.� o� �e�0.,���'a�k 'gj� f�q�.� d� wQ� �„� �W�I/,¢ _ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />rp PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />O�S�G��oti3� T�N, w�� �✓��'1� 0.�0 lO�Sid �WNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />/ • APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCFL TAX I.D. NUM6ER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />CONSTRUCTIONLOANLENDER,ADDRESS,TELEPHONENUMBER <br />, � ' � 93 <br />PROJECT ADDRESS sicNnrurje onTe <br />/� �^�l� C�.� CITY BUSINES LI �NSE NO <br />PLUMBING MECHANI L <br />NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br />WATER CLOSET (TOILET) � A/C—A/HNDLG UNITS—H.P. � <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 ; �,�ENTILATION FAN ; <br />DISHWASHER � RANGE HOOD � <br />LAUNDRY TRAY ; WATER HEATER � <br />CLOTHES VVASHER � 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 I <br />SINK (SERVICE--BAR. ETC.) ; ', <br />� <br />� <br />� <br />� <br />SUB TOTAL $ ; <br />PERMIT $ � <br />TOTAL FEE $ ; <br />FOR OFFICE USE OMLY: <br />FRONT SETBACK REAR SETBACK <br />USE ZONE LOT AREA <br />TYPE OF CONST. NO. OF STORIES <br />SIZE OF BLDG. <br />OCCUPANCYLOAD <br />REASON <br />INTAKE BY <br />��, . <br />FIRE SPRINKLERS RED'D <br />F113E ALARM REQ'D <br />PLANS APPROVED BY <br />DATE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />SIDE SETBACK PLA�J CHECI< NUMBER FEE <br />d%l� _�'' � (,� <br />VACANT SITE FEES VALUATION <br />YES NO gUILDING <br />occuPnNcv No aF owE��iNc urvirs �,~ <br />caouP PLUMBING <br />BASEMENT MECHANICAL <br />f I YES C] NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />RECEIPT NO. <br />