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I SLCc <br />APPLICATI" FOR CON9fRUCT''")N PERMIT <br />TO BE COMPLETED IN BLACK INK --PLEASE PRINT <br />f ivn'IOble- alherT„is. P,61ric, <br />BUILDING DEPARTMENT I HEATING SYSTEM: �6 GAS ❑ ELECTRIC ❑ <br />59-8810 <br />EMOLITION X COMBINATION BUILDING MECHANICAL gPLUMBING '-i SIGN <br />OWNE�R MAIL ADDRESS �/ C'.TY 2W PHONE <br />r rr NAB/e %J� cl "n iL�O/ 9�n ri�nz''a ' n %<m' l�/�i /o(? J/fi i <br />1!I!T MAILADDRESS Cm Zip PHONE <br />a L In 46rUrnfc-y4sae- <br />SW 5crAa <br />6Lr3 VorC/7nld <br />DIT('*,r <br />5Q3 Jy(n3Q.)-:y <br />ARCHITECT OR ESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />GENERA* CONTRACTOR <br />MALL ADDRESS <br />CRY <br />2N <br />PHONE <br />STATE LICENSE <br />Sa Rne. a s <br />g6Ouv <br />MECHA IOALCONTRM.TOR <br />MAIL ADDRESS <br />CITY <br />LP <br />PHONE <br />STATE LICENSE* <br />i-0ke <br />�ID� IR�ay <br />se Sn hdmis+ NJ <br />rcnE <br />ra�sr <br />PL L16ING <br />CONTP(q�ACTOR <br />.lc Ifli YT b1 r... <br />MAIL ADDRESS <br />1 /1'l <br />CITY <br />ZIP <br />viA Infi) S/ V <br />PHONE <br />ia71% <br />STATE LICENSE* <br />A , :) --% R n <br />CONTRADT PRICE OF WORK �I <br />130. 00 ./ o 310 <br />DES�!I E WORK AND fyARE FOOEACE INVOI VEpr- <br />C.Oh$'rr 4C l('lanlrl <br />CONTACT PERSON AND PHONE" <br />moire Or A IA 5�(/� <br />UO s� fI . <br />4 �V ZL;) - 001 0003 <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 />OWtJER OF THIS PROPERTY TO PERFORM THE WORM, FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW .21 RCW AND 296.200 WAC. <br />PROPOSEDUSEOFBUILDING <br />RCS / �P/ E1L <br />LEGAL DESCMPTION OF PROPERTY ISHOwN BELOWOR ATTACH TWO Co=1ESI <br />LOT -7 BLOCK DF Lod r P He/' rr r <br />L L p <br />VU(. IO 0 1 IF/ AiS ��C 0 I mC644 C) <br />/�jI J ` // J' t L / /' ( <br />Au(L Cdr (Aunty o7 �jTr/idm 0�, Ito rr uY arAll /on <br />(PARCEL TAx10 NUMBQER� / p / <br />1 0/!l1 r, �.t/nK 11ri{ ES f4 jr CEY,/r <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />J�JS e 0i� o�7oaos /3LK 00.1 0-00-Lol <br />PROJECT 3 s C�/6 <br />swNAru4L RATE <br />CITY BII9PIE55 I.CENSE NO <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 />U <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 />i <br />SHOWER <br />CLGTHES DRYERS <br />' <br />KITCIMEN SINK & DISP <br />VENTILATION FAN <br />DISHWA IR <br />"? <br />RANGE H70D <br />I <br />Q <br />LAUNDRY TRAY,!ATER <br />ATER <br />' <br />CLOTHES WASHE <br />Q <br />WOOD STO E <br />URINAL <br />METAL FIREPLAQE_(WOOD BURNING) <br />' <br />_ <br />DRINKING FOUNTAIN <br />Q <br />FIREPLACE INSER. <br />i <br />Q <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVL-NTERS <br />GAS PIPING <br />ROOF DRAINS-9AINLEAOERS <br />(D <br />EXHAUST FAN <br />T <br />SINK (SERVICE -BAR, ETC,) <br />I <br />I <br />I <br />I <br />I <br />- <br />I <br />I <br />I <br />r— <br />SUBTOTAL $ <br />; <br />SUBTOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />I <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: --owl 9-1 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PUN CHEC/K NUMBER <br />FEE�%% / <br />S <br />RECEIPT <br />/N,O <br />�J <br />�r <br />�r <br />5 <br />/7C�'7 <br />%�/� <br />ljCJ <br />USE zoN <br />LOT <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />�-- - — <br />!AREA <br />I �O <br />❑YES ❑ NO <br />TYPE Of CONST <br />--i✓✓iTy' <br />NO OF (CRIES <br />OCNwNtr <br />GA <br />NO IN W�LLMG Ann <br />'Ji <br />2 <br />--�--" <br />SIZE �DO <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />X <br />MECHANICAL <br />❑ YES NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />" <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />vol <br />I/ii0 <br />(,,VI <br />OTHER / Z - <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY PLANS APPROVED BY <br />jM <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />TOTAL <br />n <br />Y V� <br />DATE /7 O3 <br />TAX CODE IS 3105 <br />