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APPLICATI,,w,l FOR CONSTRUCT''", N <br />PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />1� <br />HEATING SYSTEMGAS J ELECTRIC <br />BUILDING DEPARTMENT' -- F <br />259-8810 <br />DEMOLITION COMBINATION XBUILDING MECHANICAL <br />I PLUMBING SIGN <br />ZP MAILADDRESS Y <br />Pq <br />iI/ <br />L <br />AsaOW"R <br />�i�i/1 <br />TErIA MAIL ADDRESS CITY ZIP PHONE <br />_S EN AO/ y �ii 4(57, SEE B&,Alla <br />ARCRITECTORDESIGNEH MAIL ADDRESS CITY ZIP PHONE <br />Sµr/tea/ Llo✓sr. )'1?.:s 38� A- �i!i �f iA4 M2 <br />zzA3 __SN/v�r iLQ&l-.HT <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP -HONE <br />zammr <br />STATE LICENSEE <br />ME HANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />STATE LICENSED <br />PLUMBING TRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE F <br />CONTRACT PRICE OF WORK <br />3P68 <br />Lin slf&oy 3�7�77N33 _ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVEC <br />CONTACT PERSON AND PHONE NO , <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTIONOF PROPER IY GHOWN BELOW OR ATTACH TWO LOPIESI <br />D A, L,� /(ys Ii� <br />J] <br />NOT. THE L38ANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />THE PROVISIONS OF ANY <br />LOT — BLOCK --�„ — OF <br />AUTHORITY TO VIOLATE OR CANCEL <br />,5,"r -4 <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 WAG. <br />_ <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPH NE NUMBER <br />B 2rd_v_td <br />PROJECTADDRESS7AA <br />xa"A1pP` u.Te —_ <br />CITY AUSnrtioorfNs NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. I TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A)C-A/HNDLG UNITS-H.P. <br />' <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />r <br />LAVATORY (WASH BASIN) / <br />T- <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP / <br />VENTILATION FAN <br />�r <br />DISHWASHER <br />RANGE HOOD <br />L <br />LAUNDRY TRAY <br />__ <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />MFTAL FIREPLACE (WOOD BURNING) <br />URINAL <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />1 <br />1 <br />T <br />1 <br />SUBTOTAL $ <br />SUBTOTAL $ <br />1 <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: _ <br />FRONT SETBACK REAR SETBACK <br />//� I Iwjrvr <br />USE ZONELOTAREA <br />E <br />TYPE Of COST NO OF STORIEC <br />FIRE SPRINKLERS REDD <br />LOAD I FIRE ALARM <br />.NUKE BY PLANS APPROVED BY <br />J <br />DATE I I /.% x / <br />SIDE <br />PLAN <br />VACANT SITE <br />/. YES NO <br />�CC.7 <br />BUILDING <br />PLUMBING <br />•^��^••— <br />'-- <br />ocNefgr Ma wwxtulx: uxus <br />MECHANICAL <br />BASEMENT <br />-'. YES '9 NO <br />ADDITIONAL. PLAN CHECK <br />HEIGHT LIMITATION <br />28 �j <br />OTHER <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />/ <br />R <br />2" <br />