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e <br />APPLICATIOk_ _:OR CONSTRUCTI,,,.J PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: U GAS U ELECTRIC U <br />-- <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />rT C1Cr,17 :� <br />V <br />'�G. �?, <br />/r <br />L`D'r ��'� �'� ��^^1 <br />�r�•-•�-✓/1./r ��-'/� <br />�1''---_i ���,� <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />ZIP <br />PHONE <br />L OC6M/LN L-7N•�(/r <br />;PITY <br />�1 `, 1��'~� <br />.✓/�-A��D� <br />�('.���i <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />Sd <br />f - .,.ac.� S.. .. <br />_ZZti' S P/3y <br />767- Sys' /hCC/r fe JyaN <br />7.1ECHAN$%f( RACT <br />It N <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE) <br />y�Firw ^ AnnITInN i/ALTERATION REPAIR DEMOLITION WOODSTOVEJFRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORN ��J �[/ v r/ <br />CONTAV PERSON AND PHOI'E y NO. <br />//I <br />DESCRIBE WORK AND SOUARE FOOTAGE INVO'.VED <br />PROPOSED USE OF BUILDING ?- '^33 <br />O/ A.,n.,,.,� /�ya,�. n;>n. wrl+Md,,•rr '/Yn/ri,_.AA.rr.. �/ <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 RCW AND 296.200 WAC. <br />zICNAIun[ " WE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRESS ' <br />C'll ;��' <br />C11YOUSINFSSUCENSE NO <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H. P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK IS DISP <br />VENTILATION FAN <br />_ <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC) <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />lf I1lCIfNG I ICC ^ul V. <br />FRONT SETBACK <br />•WEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBECR� <br />FEE <br />RECEIPT NO <br />n <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS ALLOWABLE <br />TYPE Of CONST ACTUAL <br />GWUEANv <br />NO OI BWDUNG UNIIS <br />GROUP <br />PLUMBING <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />, SOS <br />OCCUPANCY LOAD FIRE SPRNKLE RS REO'D HEIGHT LIMITATION <br />SPRINKLER <br />I <br />Y� � 5 <br />REASON FOR SPRINKLERS <br />CODE <br />STATE BUILDING SURCHARGE <br />T <br />$Z <br />INTAKE BY <br />PLA SAPPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />5;? 7 S-S <br />