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APPLICATIC"-a FOR CONSTRUCTr""iN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT 0 ffm <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION <br />❑ COMBINATION <br />❑ BUILDING <br />❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />E'0" _TT <br />PLCP_AL_ ys2z <br />Lf/OIZJ62L 'U WN4 <br />33`i- <br />q0a>3 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />' <br />4 <br />11 , • <br />�I1 <br />� 1 <br />, , <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />AVJ Kit iJ V <br />Ss03 Lgi,,c <br />Ave_ N•� <br />p -D . wh <br />9Fiosz- - 885 o8�FZ <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE L�ICE14SE a� <br />%% <br />1` <br />M ItIf <br />,I <br />I. <br />UT <br />JI aZL/� o�Lawl L. <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSED _. <br />PLUMB.NC CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Q£rrt0%/t ULt> tit V <br />CONTACT PERSON AND PHONE NO. <br />1 n1sTftL L- W &AjA3l &4to- s► be1 <br />61kaTIQ QXLtlnl'r•sTeaugc kuiAAb - ` 9G-o! <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 OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAN 8.27 RCWW A�6.200 WAC. <br />Y 1 <br />PROPOSED USE OF BUILDING <br />L— <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDIg,ARgaLSS. TELEPHONE NUMBER <br />— <br />PROJECT ADDRESS _ <br />h�l /y1�� <br />,/✓� �I�-C/IOY/L.VV <br />9GN,,iURE <br />ATE <br />CITY BUSINESS LILENSE.9 <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/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY /WASH BASIN) <br />UNIT HEATERS —BTU. M <br />— <br />— <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOT HES WASHER <br />WOOD STOVE <br />i <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HE, T PUMP <br />_ <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUBTOTAL $ <br />SUB TOTAL $ <br />; <br />PERMIT $ <br />PER.MIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REA SETBACK ( <br />SIDE <br />PLAN CHECI�NUM ER <br />FF�E,^ /� <br />('r/JVJVAL`UUATION <br />RECE�211_11 <br />'`('`'FEES Cll <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEE <br />— <br />❑ YES ❑ NO <br />BUILDING <br />5271 <br />TYPE OF CONST. <br />NO. OF STORIES <br />=URANC' <br />No. Or NNEILmG UNITS <br />GROUP <br />PLUMBING <br />SIZE OF BLDG, <br />FI'TE SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />—II— <br />OCCUPANCY LOAD <br />rIHE ALARM REO'0 <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />i <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPRO Eq BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />v` <br />LOCAL SALES <br />DATE I q,) <br />TAX CODE IS 3105 <br />TOTAL <br />7 i�O <br />WL <br />