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APPLICATIC J FOR CONSTRUCT JN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: U GAS <br />U ELECTRIC <br />U <br />BUILDING DEPARTMENT <br />259-8810 <br />i DEMOLITION <br />COMBINATION <br />MECHANICAL <br />PLUMBING SIGN <br />OWNER <br />and/P E <br />�LBUILDING <br />MAIL ADDRESS <br />, <br />CLJ. �. cJ �nx 37n7 <br />CIy� 21P <br />�17 oJ" 7G SLr;T� w� <br />PHONE <br />9�G/z,Y <br />3(?- -73 <br />TENANT <br />MAR A I�O'E <br />CITY <br />ZIP 2 <br />PHONE <br />ARCHITECT ORDESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LoctwooD <br />G2 2j— <br />O1NRACTTTOOORR' <br />GENERAL CC/ <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE E <br />S <br />MECHANICAL CONTRACTOR <br />MA ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />CLASS OF WORN <br />I I ., .lV�ITVI\I Yel rcoennN REPAIR <br />DEMOLITION <br />WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />' <br />CONTACT PERSON AND PHONE NO r <br />CONTRACT PRICE OF WORK -c e.4 <br />OESSIBBE WORK AND SQUARE FOOTAGE INVOLVED <br />crrcw) e2i 8 <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />*/T,DE &I A-C- <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />Me)ti„" 6 or- ff.hY v-> Hq-re <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 FOUR COPIES( <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <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 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 RCWW AND 296.20/0 WAC. <br />Y /. 15 -f .NDlla- <br />W. UM v JOE <br />PROJECT ADDRESS <br />011 RUSINFSSIKlNSF NO <br />300Gv. CAas; 00--O <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />. <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />_ <br />run VrrEAAc vac <br />FRONT SETBACK <br />vnii­E. <br />REAR SETBACK <br />'IRE SETBACK <br />PLAN CHECK UMBER <br />_ 21 <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />eye <br />TYPE Of LONtS AL WAS E <br />1/.A/ FI <br />TYPE Of CO ST ACNA` <br />ottp..va <br />_ <br />'m a rnrinmc eyi TS <br />PLUMBING <br />MECHANICAL <br />------------ <br />SIZE OF BLDG <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />yf' I 30 <br />OCCUPANCY LOAD FIRE SPRINKLERS REO'D HEIGHT LIMITA710N <br />1 yi[ <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />-S`6 <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS P OVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 31105 <br />1 TOTAL <br />/ 9 / / r6 <br />• <br />