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APPLICATIO.. FOR CONSTRUCTI rN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT Oorerr <br />HEATING SYSTEM: U GAS <br />U ELECTRIC I] _. <br />BUILDING DEPARTMENT <br />259-8810 <br />1, <br />I I DEMOLITION I I COMBINATION )(BUILDING <br />MECHANICAL I I PLUMBING I I SIGN <br />OWNER MAILADORESS <br />�'6rM<i Go• R a. <br />CITY / 21P 'TTONE <br />(3ox 3707 e! S F7_F -,6 SE�7i,6 t✓� 9RZ 3�2-73s9 <br />7-14 <br />Ent <br />TENANT <br />CRY <br />Ir NV NE <br />ARCITITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PITONE SLATE LICENSER <br />7"I!-E? 1-1-vs T / fl C J , <br />-- <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE STALE LICENSE) <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE STALE LICENSE <br />CLASS OF WORK <br />. .._... ocaella I I nPMOLITION <br />I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />I I IvEYV I AuuIllvi. i .... �. ......... .. _...... <br />Cj <br />COPTACT PERSON AND PHONE NO <br />�-Of/R'/L� 2`4•--y•r 3 <br />CONTRACT PRICE OF WORK 90 n00/ 1 <br />iTtSH'1(�ok5k.( <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />0—oi m icA(- <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 />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOE <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 />l c�,2/9L- <br />�UIIE <br />PROJECT ADDRESS <br />A-2 �S/ <br />DATE <br />urvousNSSE ENSENo <br />30b-3 (v.-/{S/Nd <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITFM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />T <br />NC—A/HNDLG UNITS—H.P. <br />BATHTUB <br />_T_ <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />,— <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION PIN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE IN .EAT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK ISERVICE—BAR, ETC) <br />I <br />-- <br />I <br />SUB TOTAL $ <br />1 <br />SUB TOTAL $ <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR SETBACK <br />USE ZONE LOT AREA <br />I YPE OF COALS ALLOWABLE TYPE Of C NA A( <br />s1iE of BLDG. <br />DLGU PANCV LOAD <br />• 1E11 1%)1 <br />REASON FOR SPRI! <br />cBOt% <br />INTAKE BY <br />I -1`4 <br />NO OF STONES <br />FI S/P( <br />E7 <br />SIDE SETBACK <br />VACANT SITE <br />pCCImANLr NV M1M'IILII6UNIIS <br />BASEMENT <br />0 HEIGHTLIMHAIION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PLAN CHECK NUMBER <br />/EE <br />RECEIPT NO <br />4 70 <br />FEES <br />VALUATION <br />FEE r_ <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />AL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />y �' <br />PUBLIC WORKS <br />I <br />TOTAL <br />I <br />��� ' <br />