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APPLICATI�1 FOR CONSTRUC'�-�ON PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> '�l v 1 v � HEATING SYSTEM: fj�GAS ❑ELECTRIC CJ <br /> BUILDING DEPaATMENTI V — <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION C� BUILDING ❑ MECHANICAL ❑ PLl:i�ABING ❑ SIGN <br /> OWNER MAILAOORESS CIN 21P PHONE <br /> MGMA 320 108th Avenue NE ge�levue 98004 <br /> TENANT MAILA�ORESS CITV ZIP PHONE - <br /> Godfather's Pizza 4809 Everqreen Way Everett WA 98203 <br /> �. ARCHITECTORUESIGNEF MAILADDRESS CITY ZIP PHONE <br /> Design/Build Services 1124 Eastlake Ave E�eatiLP. WA 4810Q F�u-u778/fax 624-4686 _�_ <br /> GENERALCONTfl CTOR MAILAOORESS CITY ZIP PMONE STATELICENSEI <br /> Ir� be c�e��v'rn�n��.Q -- - <br /> MECHMIICFLCONTRACTOfl MAILADDRE55 CITY ZIP PHONE STATEIICENSE� <br /> � PLUM8ING CONTRACTOR MAIL ADDFE55 CIN ZIP PHONE STATE LICENSE t <br /> CONTRACT PRICE OF WORK <br /> $30,000 <br /> DESCRIBE WORK AND SOUA9E FOOTAGE INVOLVED C'�NTACT PEFSON AND PHONE NO. <br /> Remove existinq annex at rear of ro'ect s ace <br /> E rebuild new structure in same location. Elimina e � �� <br /> �JOYYIOfI of structure encroachin It110 CIY RI f1t I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED TF�IS <br /> PROPOSED USE OF BUILOING Of WBY. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ` Re�*���rant PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> LEGAL�ESCRIPTIONOFPROPERN�SHOWNBELOWORATfACMTWOCOPIES� WORK WILL BE CGMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> attached NOT. THE GRANTING OF A PERMIT DOES PJOT PRESUME TO GIVE <br /> LOT — BLOCK oF — AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE CF CONSTfiUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPER"iY TO PERFORM THE WONK FOR WHI.^.H <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL'fAX I.D.NUMtlER GONTRACTORS LAW 18.27 RCW AND 296.200 WAC. . <br /> 4102-000-001-008 <br /> CONSTRULTIONLOhNLENDER.ADDRE55,TELEPHONENUMBEP J � <br /> {�� I <br /> � yy�a — pATE <br /> . PROJECT ADDRESS SIGNAiME _ <br /> 4809 Evergreen VYay-Claremont Jillaqe GIiT0U51NES5lICEN5E.N0. <br /> � PLUMBING Tem . Ca . see se a�-��:te TI Permit. MECHANICAL <br /> ryp, TYPE OF FIXTURE OR ITEM � FEE NO. TYPE OF Ef.UIPMENT FEE <br /> - WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.R � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � _ <br /> LAVATORY(WASH BASIN) � UNIT NEATERS—B.T.U. M ,T_ <br /> SHOWER ' CLOTHES DRYERS � _ <br /> KITCHEN SINK 8 DISP � ' VENTILATION FAN � <br /> � DISHWASHER � RANGE HOOD : <br /> LAUNDRYTRAY ; WATER HEATER ` <br /> CLOTHES WASHER � WOODSTOVE I ' <br /> URIDlAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> � <br /> DRINKING FOU�TAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADEFS � EXHAUST FAN ' <br /> � �SINK(SERVICE—BAR,ETCJ � , <br /> � ' <br /> , <br /> � <br /> I <br /> ; <br /> � <br /> SUB TOTAL S ; SUB TOTAL $ ' <br /> PEFMIT S PERMIT 5 � <br /> � TOTAL FEE 5 ' _ TOTAL FEE_ $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REhR SETBNCN SIDE SETBACK PLAN CHEC N MBEa FEE/ L �� RECEIPT�. � <br /> fl, , �/ � <br /> USEZONE LO AREA VACANTSITE p FEES VALUATION FEE <br /> /� � n i <br /> � _ Z ^ � YES NO BUILowG �C� G ' <br /> 7VPEOFCONST. NO.OFSTORIES oCtuPaNtr NO.OfOwEluqGUNIiS � <br /> i <br /> T/'A� / �z � PLUMBING � <br /> _y.l\I � <br /> S 0��1DG�,n� FIRESPRINKLERSREO'D BASEMENT MECHANICAL � � <br /> � f �NDUrI Y�IATTlM�OF�I.I, ❑ YES '�NO ; <br /> ADDIT104AL PLAN CHECK � <br /> OCCUPANCYLOAD ' FIREALAPMREO'0 HEIGNTLIMITATI� i <br /> ��' Y� �S OTHER � <br /> i <br /> ' REASON <br /> �Ifn�Uy� �N .•nnilVG'��I �/f1��.` �' �/.j��J(����-� STATEBUILDINGSURCHARGE �L7— <br /> !V/7/LvF/ Wl�n' ! <br /> INTAKE BV PLANSAPPPOVED BY CITY OF EVERETT PUBLIC WOFiKS � <br /> JfJ� LOCALSALES �n /�;�� <br /> DATE (� � � TAX CODE IS 3105 TOTp•� �S �� <br />