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APPLICATION FOR CONSTRUCTIOW PERMIT eve« Xt <br />the EwlpT//R TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF Lei <br />everett <br />BUILDING DEPARTMENT HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑ <br />259.8810 <br />DEMOLITION I COMBINATION BUILDING ECHANICAL P UMBING SIGN <br />OWNER MAIL ADDRESS CITY Z17 PHONE <br />1106/14 <br />6 <br />GOINFANY Nli)# BAY 4SfE0494, �LD�j 40 - 25 GG -GG 00 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />MAIL ADDRESS <br />CITY <br />PHONE <br />GENERAL CONTRACTOR <br />AUSAN Co. <br />MAIL ADDRESS <br />P.o. Box 2?57 <br />CITY <br />Ev4urr A, <br />ZIP PHONE <br />gH2a3-o?S7 166 460 <br />LICENSE/ <br />71301AUs7/cT377Nj <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE/ <br />toSco P" Poo <br />KntK! <br />44 9,013 621-96S♦ <br />coscoFP/?2UA <br />PLUMBING CONTRACTOR <br />_ (. \ <br />MAIL ADDRESS <br />CITY <br />iIF PHONE <br />LICENSE <br />C OF WORK U <br />NEW I ADDITION I I ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT iJ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK /`/ <br />CONTACT PERSON ANO PHONE NCO/ �7 L c <br />N /771 ("q p J <br />DESCRIBE WORK ANO SQUARE FOOTAGE INVOLVED <br />40SGO 161" P/24:7 Z"40X <br />PROPOSED USE OF BUILDING <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 18.27 RCW AND 296.200 WAC, <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />cosco j?R,E /ko7XXt�noN <br />�� <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT— BLOCK OF <br />PROTECT ADDRESS <br />_ <br />APPLICANTS CITY BUSINESS LICENSE. NO AND BUSINESS NAME <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—ATHNDLG 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 />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_T _ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE B CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />RCAF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />J4%r <br />Aprp / CLTE <br />/19 <br />SUBTOTAL A <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />' <br />_ <br />TOTAL FEE $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />'RONTSETRACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NU jA 14J� <br />FEE <br />RECE111110 <br />JSE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />--- <br />---- <br />TYPE Of CONTS ALLOWABLE <br />TYPE Of CONST AC104 <br />acuvrrcr <br />rw amrrnitc oriH <br />4R°'v <br />PLUMBING <br />SIZE OF SLOG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />)CCUPANCY LOAD FIRE SPRNKLERS REDO HE IGHT LIMITATION <br />OTHER <br />/5 3 <br />T <br />_ <br />1EASONFORSPRINRENS <br />— <br />STATE BUILDING SURCHARGE <br />WAKE OY <br />PUN APPROVED BY CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />--Y— <br />' TAX CODE IS 3105 TOTAL <br />53 <br />