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5I <br />APPLICATION'OR CONSTRUCTIC `) PERMIT F <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT F <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS U ELECTRIC <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING I I SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE. <br />BOEIA/G CbMGaA/y 3DO3 W,CAsMA,o Rd. EE/iERE7T 98Zo3 .74A6,-'4o&s- <br />TENANT }MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />3oE/rJG 4Tm A,, acn a ul. cgSEA)'? <br />Au, ,EUeae7j- <br />nf8aos <br />1GG - 4oG5 <br />ARCHITECT OR DESIGNER MML ADDRESS <br />CITY <br />ZIP <br />PHONE <br />�•-TAJ CoMPAN _PToI f5o .2355 <br />EVt2Eii <br />98.Z03 <br />EGG -`739RCLST/c' 14,07 <br />GENERALCONTRACTOR IMkI. ADDRESS <br />ausTY °• ax <br />CITY <br />ZIP <br />PHONE STATE LICENSE <br />Al _C „p + - -?s'7 <br />.E !/z2671 <br />98�0:4 <br />EGG 93910 Aa-sn cr 377.v3 <br />MECHANICAL CON TRACTOR MALL ADDRESS <br />r -_ I _ I ._ _ _ <br />CITY <br />_ _ It <br />ZIP <br />-- <br />PHONE STATE LICENSER WA CL •� <br />_ <br />InebVnmAUVX NEAR.AUll¢ss CITY ZIP PHONE STATE LICENSER /./O$7 <br />FUG-Gi/IA�EJ (::oM' <br />?y ;?w 22o2fi':CMc/0 <br />CLASS oFWORK . <br />K NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK <br />CONTACT PERSO'1 AND PHONE NJ •)p •Sptl <br />PILL- �wj/E/Q CR�D6/ o� q-,9-7 <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED - .--C.0 <br />AMR PtAAJE <br />PROPOSED USE OF BUILDING r - i-.+...� <br />-17-e-7 • <br />I 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 10.27 RCW AND 296.200 WAC. <br />x�l "nip---- 3-19-92 <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES, <br />LOT_ BLOCK OF <br />/a.c. •=ARC L.M.I <br />PROJECT ADDRESS) �/ <br />3Ao3 edt�T CASMA/O n AC /� OS/ <br />saNATUPE RAT[ <br />CITY BUSINESS LICE NSF NO <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-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 6 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />_ <br />T <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />gl'?bd <br />FEE E�o <br />I 1--pe <br />RECEIPT NO <br />� S/Y � <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS ALLCNABLE <br />TYPE Of CONST ACTUAL <br />BttIPMrn <br />GRCLP <br />T Na w.11L. e„Y Is <br />I <br />PLUMBING <br />— <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYLOAD FIRE SPRNKLERS PEGJ HEIGHT LIMITATION <br />_ <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />DD <br />STATE BUILDING SURCHARGE <br />; <br />INTAKE BY I <br />7APPROVEDBY <br />' I rI <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />