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■ <br />APPLICATIC1 FOR CONSTRUCT`IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEALING SYSTEM: )4GAS ❑ ELECTRIC J <br />259.8810 <br />❑ DEMOLITION COMBINATION Ft BUILDING ❑ MECHANICAL ❑ PLUMBING Ll SIGN <br />OWNER I MAIL ADDRESS / CITY ' L ZIP PHONE <br />"all f 11 /Af S1�17 JZ tTr ,� Rid Fi,e•ti l .311 -— <br />TENANT MAIL. ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 21P PHONE <br />CLIA y",c ><- ___ �S5-873s <br />GENERAL CONTRA TOR MAILADDRESS CITY ZIP PHONE STATE LICENSE# <br />�AfSfM cur', 15802 a3" (5I NF. S;A,{kmsl� �l�90 33L(-77J3 1ARScC � /014H <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY Z!P PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY nr e ucervoeN <br />A 7 rriPTSDT -f 1.71RD <br />CONTRACT PRIC: OFW RN�/ Od <br />DO <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />. CD e — or OD s / <br />'14rSGrT C'unsl 33H--7733 <br />n I <br />////Y l'�fl%/) elt..,���� <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 r <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 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 WAC. <br />PARCELv BFR <br />--6, <br />l -GD -�G o <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />5-9 o0735 <br />PROJECT ADDRESS L l I NGY <br />( IOF / <br />e <br />r 1SKIWATURE <br />!-f�l <br />LItV BU5MES5 LKEN5E N° <br />PLUMBING IMECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />ANC—AIHNDLG UNITS—H.P. <br />2 <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEATPUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />---------------- <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />t: <br />IEEE <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />I' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $'I <br />TOTAL FEE $ <br />' <br />vnn nCLInL I ICG nAII V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />r r <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />(j S Do <br />' J <br />TYPE OF CONSI <br />S IJ <br />NO. OF STORIES <br />Z <br />°GGuPwy <br />rvj° <br />3 <br />NO V INALLINGUN115 <br />SIZE OF BLDG. <br />TLI 71a <br />FIRE SPRINKLERS RED <br />N� <br />CASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />i — <br />OCCUPANCY LOAD <br />FIRE ALARM AEG D <br />HEIGHT LIMITATION <br />OTHER <br />I <br />REASON <br />STATE BUILDING SURCHARGE <br />� <br />INTAKE BY <br />PLANS APPROVED BV <br />�} <br />DATE J3 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />!_ C jL! <br />