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�a <br />f u q <br />fol <br />m <br />APPLICATIC` 1 FOR C®WSTRUCt-4 N PERMIT <br />\ <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />N I I DEMOLITION <br />COMBINATION XBUILDING MECHANICAL I PLUMB'-'G SICK <br />OWNER <br />Mb�� <br />MAIL ADDRESS CITY ZIP PHONE <br />w� <br />IyIL 0ZS.t .CVcQt-- N MhL�.Wby �►ADDRSS <br />CITY <br />Aloof <br />SC4�I�Si L3p\Ay- <br />- Li -VA AVE.'fwo(wb SQ;-Vftz LaLI�, `I$12-I &,OL- S8-1�3`1 <br />ARCHITECT OR DESIGNER <br />A 2oz5 <br />MAIL ADDRESS CITY ZIP I PHONE <br />T-42Si 4lle. RSa MPIy'Pwp-`fbt.:,e(Z R.�Wa�aIZ1 &4I.Agpy330 <br />GENERAL CONTRACTOR +MAIL <br />ADDRESS CITY ZIP PHNE STATELIQENSEN <br />KF,- cons�cron <br />P.o .lax r4� k1RY11wp 4.1�. D63-�84y ('sue `38 ggco W3lkmcc.I g F <br />MECHANICALCONTRACTOR <br />MAILADDRESS CITV 21P P11D E STATE LICENSES <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE STATE LICENSEa <br />CLASSOFWOBK <br />!_I NEW I ! ADDITION <br />X ALTERATION REPAIR DEMOLITION WOODSTOVEFRPLIIISERT i BUILDING RELOCATION <br />I I•I,NTE!`.T OC•iCf1N GNM1 OY/1NF NI1 % � <br />aZl �N� r <br />I �! <br />FOR OFFICE USE ONLY: <br />CONTRACT PRICE OF WORK 1\ `J�VCr <br />.y �( <br />I`loutii 1_1y�'JC-I\� `I�TO�9�q <br />""1 �,LJ� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOL ED <br />ADD taabl or_ Roam k 3 CWA, <br />, L, k <br />ncS <br />PROPOSED USE OF BUILDING ' <br />^ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO SE TRL E 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 />PERFORMANE':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 LAW18.27 RRCCW AAN,D296.200 WAC. <br />X/ v 1�' \ ' <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_ BLOCK OF <br />PROJECT ADDRESS <br />Iuo2 5,E. Eur-e> nu -wiNy <br />5mv- I a <br />s'NA'uPl V zscl0 DATE <br />c,T.DDs,,ss„cENSLr:O <br />,F <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 />ArC—AJHNDLG 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 />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRYTRAY <br />_ _ <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />i <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />i <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN C IECK NUMBER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE �OF iC�ENT�S. ALLOWABLE <br />:5j <br />TYPE OF rnCONS�T. ACTUAL <br />vi <br />m�mo"Auh" <br />15� <br />NOgPxFLLINGLMTS <br />'e- <br />PLUMBING <br />—�— <br />SIZE OF BLDG, <br />282 fw <br />NO. OF STORIES <br />I <br />BASEMENT <br />)JO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO'D HEIGHT LIMITATION <br />N� <br />REASON OR SPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE BY <br />PLANS APPROVED BYFTALXOCCI <br />J M <br />Y OF EVERETT <br />AL SALES <br />DE IS 3105 <br />PUBLICWORKS <br />TOTAL <br />— I <br />