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1G <br />h <br />APPLICATIGA FOR CONSTRUC7.JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT F HEATING SYSTEM: U GAS ❑ ELECTRIC /� h A <br />259-8810 <br />DEMOLITION COMBINATION BUILDING AMECHANICAL k PLUMBING SIGN <br />OW`2NED MAIL ADDRESS CITr ZIP PHONE <br />I7 e-)yio 3003 C/}SIA/O 12c� EvEa2�� 9PoZ3 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />SAm f- <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />714E X.5nA/ <br />Co. %do <br />5, J, /,•" 5i. <br />RiiI-ol✓ <br />IfF.0 ZZ/'�Zoo <br />GENERAL CONTRACTOR <br />/ivS / <br />MAIL ADgR�ESS <br />Co <br />0/nJ <br />CITY ZIP <br />Z 55-7, FyA.!w rr <br />PHCFE <br />STATE LICENSE 42 -- 0. <br />/ <br />977203 <br />2�[� //9of� Sr SG T37 i <br />MEAN7j+F <br />CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />N j <br />-6mAAj4GU <br />_3oX <br />�/ <br />MIL.I.60— do <br />5lL- I I ,, /O�DAL <br />G 7/7 (f�/�/�TS�ENSEE <br />\ <br />PIUMBy�410((��C�^,^ONTTRACTOR <br />`' <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE• <br />, ""F_ <br />MACDa4liyen <br />CIAS OF WORK <br />'A,NEW . ADDITION ALTERATION <br />REPAIR DEMOLITION <br />WnnnRTC)VF,ra PI <br />INRFNT RIM pi om, fl/�dTfxu <br />CONTRACT PRICE OF WORK (yyy Ztjy <br />/ <br />CONTACT <br />F4I6,EDO5164 -- — <br />9VC)IAND PHONE <br />AA <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />l H7 <br />-7(a3 9yp0 <br />PROPOSED USEOF BUILDING <br />MAR/UFAC% <br />I HEREBY CERTIFY THAT 1 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 2296.200 WAC. <br />X <br />S'Gh T IE fJ PATE <br />8S <br />LEGAL DESCRIPTION OF PROPERTY )SHOWN BELOWOR ATTACH FOUR COPIES) <br />Lot BLOCK of <br />/ <br />-- <br />PROJECT ADDRESS T <br />CITY9US ML'CENSENO� <br />PLUMBI <br />,(j <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 />- <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.TU M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />/J <br />UNIT HEATERS-B.T.U. M -, <br />SHOWER <br />'- <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />, <br />RANGE H000 <br />, <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />-r <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />' <br />URINAL <br />10 w'— <br />METAL FIREPLACE B CHIMNEY <br />, <br />DRINKING FOUNTAIN <br />, <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />i <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />; <br />,— <br />GAS PIPING <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />?e Q y <br />,— <br />-- — <br />--'i— <br />S <br />- <br />SUBTOTAL $ <br />SUBTOTAL $ <br />�'t1zJ <br />PERMIT $ <br />PERMIT $ <br />, <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />3�'7-7 <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE Of CONTS. ALLOWABLE <br />1YPERCONST ACTUAL <br />acuvMKr <br />avAGuxc 4xrts <br />PLUMBING <br />GB00P <br />7 <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />3 <br />OCCUPANCY LOAD FIRE 6PRNKLER5 RE00 HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />i <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE By <br />P IS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />V <br />rorAL <br />TAX CODE IS 3105 <br />