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,)cif Aw"PIPMOMICATIn FOR <br />TO BE COMPLETED It <br />QC-1 �ni��EngQery if $4<)oq 1 <br />��11 GY <br />B�III BUILDING DEPARTMENT I HEATIN <br />259-8810 -.* <br />❑ DEMOLITION El COMBINATION <br />OWNER \\ MAIL ADDRESS <br />2 c� ADS o 330 It <br />TENANT M IL ADDRESS <br />\,Y7, m r _ Ic) 3-�-o iAw <br />ARCHITECT OR DESIGNER MAIL ADDRESS J <br />GENERAL CONTRACTOR MAIL ADDRESS <br />E <br />NS UCT"IN PERMIT <br />K INK —PLEASE PRINT <br />4: ❑ GAS ❑ ELECTRIC ❑ <br />Cl BUILDING <br />CITY <br />gg <br />S� <br />CITY <br />99 So. <br />(I MECHANICAL ❑ PLUMBING ❑ SIGN <br />:ZIP PHONE <br />r " w,n 3c{?_ <br />ZIP PHONE <br />ZIP PHONE <br />CITY ZIP PHONE STATE LICENSE <br />-� <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE AD 0 7 <br />r r, c'r, Qo s�X 9�0 �6 �i a$ z� w�-;�/ <br />PLU BING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br />CONTRACT PRICE OF WORK <br />350c-d <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />C NTACT PERSON AND PHONE NO. <br />^Q Z <br />Co %Yrv__ - <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 F THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIC TION IS MADE AND I COMPLY WITH THE STATE <br />CONT C AND 296.200 WAC. <br />�0 <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK - OF <br />Y 7 <br />PARCEL TAX I.D. NUMBERS <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRE n 1 Q// <br />I / ,I <br />DE <br />cN DATE <br />CIIY BUSIN SS LICENSE 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 />' <br />AIC—A/HNDLG UNITS—H.P. <br />1 <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 & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />1� <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />,V <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />'ILA- <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />o <br />1 <br />' <br />1 <br />' <br />1 <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />In 'Yronr I ICr n\II V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />�L <br />FEE <br />PECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />;G. <br />TYPE OF CONST. <br />��yup�� <br />/vol?7JW/ <br />NO. OF STORIES <br />Q,' <br />.."6_ <br />=u1AN1Y <br />GD7, <br />xDAFDx11.1-INGU9DS <br />PLUMBING <br />1 <br />i <br />SIZE OF SLDG�. � <br />Al WIr/ <br />FIRE SPRINKLERS REO'D N <br />yke;' <br />BASEMENT <br />YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />1 <br />2G 1 <br />OCCUPANCY LOAD <br />/104 <br />FIRE ALA,RM/R�EEOD <br />(y'�! <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />6`/ ✓DID/� <br />STATE BUILDING SURCHARGE <br />Q <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS AP ROVED BY <br />DATE IQ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />