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APPLICATIC 1 FOR CONSTRUCT'IN PERMIT OOL <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM GAS L <br />BUILDING DEPARTMENT ❑ E ECTRIC ❑ <br />259.8810 <br />: 1 DEMOLITION COMBINATION BUILDING rl, ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL ADDRESS CRY ZIP PHONE <br />JDN 273/ WCTNoACRUE, 60M 6M BVC,PCT7, GJN '70zoi 3-18-8460 <br />TENANT MAIL ADDRESS CRY ZIP PHONE <br />6ye067T NUTuRG :my/kk4 T5t1N� 15,02 lv�U rl 6yy2c 104foZ0l 25 S - 3(-i s; <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />JOAIC6750MRQl &P070[*V_f5lIX„60TtLt,l)l9B/o/ z-n-bz?�3 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY IIP PHONE STATE LICENSE <br />5J7L GORPDIIRj/O,U 3156 �lC/ff¢I1I7� 20f}A S,E. t�EUGGE�C lyl9 98005 65/>ycaz sb� z3l t <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CO TRACT PRICE OF WOPK <br />DESCRIBE WORK AAN,DSGO^AREFODIAG N'OLVEO _„ l'� n <br />CONTACT PERSON AND PHONE NO. <br />OA10✓�L' 6Wl,, 1'H92Trll?(, 6F1=LC6 91JI9 <br />fj/a LIMA JSUL'f1H/fk//�Z 2`jZ-Sli, <br />PA2lt& " vr/j LL <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 WHETh.ER 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 AUTI IORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />LAW T . 7 RCW AND 296.200 WAC, <br />� <br />x 3- 30 <br />PROPQ�EOUS�E•OFBUILDING �t <br />/�d,� / LO i� 010 )5-Z Ofrlec &Q,1i . <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH TING COPIES) <br />LOT BLOCK (025" OF PGRTOf EVELE]7i <br />va�of fe 3 of tsi_4715 , &:;6 3Z <br />PARCEL TAXI D. NUMBER <br />5�� At>R�NHe,vT 'A" <br />CONSTRUCTION LOAN LENDFR ADDRESS. TELEPHONE NUMBER <br />5tE A7 r&//y6k);r '9 <br />PROJECT ADDDRRE�SfSrt, <br />DATES�GeDry- <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)G-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 />; <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />r— <br />KITCHEN SINK & DISP <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />) <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />` <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR. ETC.) <br />�— <br />I <br />I <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />PERMIT 5 <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMB <br />F <br />Tim <br />awlss <br />/// O✓ <br />USE ZONE <br />LOTAREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES ❑ NO <br />BUILDING <br />0 <br />h73 <br />NO. OF STORIES <br />TYPE OF CON51. <br />12 <br />Dfb11MNGY <br />5 °uP <br />I ND.QOWFLLINGIMtfsi- <br />Ar <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REDD <br />BASEMENT <br />MECHANICAL <br />6737 -r , <br />`f�j <br />' YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED'D <br />HEIGHT UMITANON <br />7� <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />_ <br />J <br />1116a v/ & Qj"-y,'{ <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />- ! <br />V <br />LOCAL SALES <br />DATE q <br />TAX CODE IS 3105 <br />TOTAL <br />4317 <br />3 <br />