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APPLICATIC l FOR CONSTRUCT"'IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 0:7r <br />BUILDING DEPARTMENT HEATING SYSTEM: )dGAS ❑ ELECTRIC ❑ <br />259-8810 <br />DEMOLITION ❑ COMBINATION ,(i BUILDING r /, L] MECHANICAL ❑ PLUMBING Li SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />JONgrouP 6VCP_6rr,&)/t982ol 3e,40 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />EV6f6T7-Ht4iV1K-34Vi46 I3ANk I502 lvAu,:sr Eyegc jr &4 ,78201 258 - 3&-1s <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />JON&! ?-, HA�I /�G. &08 7UWE2 ;!5(.x. S9A. 04 98/01 292-0-283 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />517E G6RPorz/iT/ode 3/SD �iGf�ff2IJ5ROFIn f..3 f1/U�,k�A g&Old dW-- Av 3OL-23/ 134 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE II <br />LA RACT PRICE OF OoWORN <br />527 o 00 <br />DESCRIBE WORN AND SQUARE FOOTAGE INVOLVEDGE <br />23 �53 a�J FT. OfF/TAN t /MiF <br />CONTACT PERSON AND PHONE NO <br />Rek)r @ fGOda 6 Pifer/RCS <br />> 5%�ib9H�ki/�c�. 292-828: <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 X27 RCW AND 296.200 WAC. <br />x // IIL <br />� — - <br />a <br />PRo SED USE OF BUILDING y� <br />�� /OTU OF b-2 d Fhb <br />LEGAL DESCRIPTION OF PAOPERTY ISHOWN BELOW OR ATTACH TWO COPIES) <br />LOT / BLOCK 6S'5 OF p&4T dF6VgRtrr. <br />/JOLdFIE 3 dF f�f}TS 1194f, 3z <br />PAR;TA ID. UMBER Lu% <br />LG/L 7 [ <br />CONS r( ON LOANLENDER.ADORESS/TELEfHO„NUMBER <br />GL /G IA—,/C!V <br />PROJECT ADDRESS <br />270Co&K /3V£ �dv2 (o F�2rlg6 7 <br />sicN uxs 5 art <br />CIiYx 5RI[SS IiCLx5C 110 <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 8 DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT S <br />I <br />PERMIT $ <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHEEC NUMBE <br />�L <br />f[.I: <br />REC T <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />El YES El NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE Of CONST. <br />FP,IL <br />NO. OF STORIEg <br />l� <br />otGoMNcr <br />By <br />NO Or bw[ulxc NrKs <br />SIZE OFBLDG <br />(*[If <br />I&W7 _(*[Iff ri" <br />FIRE SPRINKLERS RED <br />BASEMENT <br />YES [I NO <br />MECHANICAL <br />�— <br />I <br />ADDITIONAL PLAN CHECK <br />441 <br />D_Rjrl LOAD <br />�l}'7' �(oTN H-' <br />FIREALAR REOD <br />HEIGHTLIMITATION <br />OTHER <br />REASON 81401 Wj& <br />STATE BUILDING SURCHARGE <br />INTAKF BY <br />PLANS APPROVED BY <br />W _ <br />DATE ( 3 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />3 <br />