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the EY.:or«R <br />c(n OF <br />APPLICATION FOR <br />CONSTRUCTION <br />evereR <br />everett <br />PERMIT 101 <br />I <br />C <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION <br />XBUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />"Wral R <br />Michael R Mastro 2201 <br />•ut u n t Inn nl Slf.,uJt <br />William S, Tsao 8, Co P a <br />Mall Aillllll 7 --co, 11V <br />6thAve Suite L08 Seattle, Wa 98121 <br />MAI: abnul'. , rt. u• <br />S same as above <br />•rr!)rll <br />441-6688 <br />I n rtn —� <br />lrl rn IMI L.ONulACTEP _--lail <br />Owner <br />,nlnu :•. •L—__— :Ir <br />same as above <br />I I rr I r ✓II —_ <br />Ic(rlsE . <br />MI II rIANII.AI CONIRA,,,TIILI <br />_ <br />MAIL AUUN[::b <br />l4! NFI <br />I•I,,MAIM. CON I RAG TOR <br />At, ANON, S'S "I� b1' <br />-- <br />I41Og1 <br />I IUJ15L , <br />CR NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ OLMOLIIION ❑ WOODSTOVElFRPL.INSERT ❑ pLALDING RELOCATION <br />.n14AbU11�)I WIMP, .l.OM nI Van WAI '. I. <br />_ <br />yCl 000 <br />,II SCNDI WURn <br />e-owoUc•j 2/ ilIJ/T -4AoW;rH4.rf <br />Rif (IF B!'N DIN❑ <br />Apartment R - 1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE <br />IN OR NOT THE GRANTING OF A PERPi.!T DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF COWPACTOP OR AUTIIGRt.rD AuENI I•AIF <br />X <br />Fc <br />lu Brsr.RIm INN OF PROPEBrrlsluwN BILLOW Oilana(:n loon coPlt S. <br />See sheet A2 <br />I•Nn.IF CI ADDRESS <br />Evergreen WayS <br />Everett <br />APl•t If AN":, 1;II t IIJ V NI titi 1 I'l rRL '10 <br />PLUMBING <br />_ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />a <br />t°EE <br />NO. <br />I TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) .111111M <br />a, <br />AIC — A,HNOLG UNITS — H P <br />BATHTUB <br />_ <br />r <br />REFRIGERATION UNITS — H P EA <br />�^ <br />LAVATORY 1 WASH BASIN) <br />BOILERS — B T U rH P <br />SHOWER <br />GAS FIRED A C. UNITS — 8 T.U. <br />KITCHEN SINK S DISP <br />FORCED AIR SYSTEMS — B T U M EA <br />DISHWASHER <br />WALL HEATERS —8.TU M <br />LAUIIDRY TRAY <br />UNIT HEATERS — B.T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYEF" <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVEN TERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR. ETC I _ <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL <br />S <br />SUBTOTAL <br />PERMIT <br />3 <br />PERMIT <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />I N11141 5f IWCh <br />See <br />"FAR SEMAC< <br />Sheet A3 <br />SIBS SETBACr <br />IILA Hy�K NUMBE <br />�! Z10� <br />far Akl� <br />I FEE 0.� IF <br />819T <br />EIPT NO <br />I'.I !I lrll <br />See 'Sheet <br />lO: aDf P <br />A 2 <br />VAt.AN15111 <br />xYL!, .Ilo <br />_ <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />.( <br />5 GS4 72 4 <br />r II'I FIT Ln451 <br />V — 1 <br />UCCUPANC1 CFFILIP <br />R — 1 <br />NO OF DWI I I NilUNQ•{ <br />Z` <br />PLUMBING <br />•':I ')I N. IRi � � <br />( <br />NO OF SIOIIIFS <br />MA, OCC I'IAR <br />v <br />MECHANICAL <br />11141 SPHINKLEHS REOUIRI.D 1.1 YIiS K NO.—,___—___ <br />DTIIFR <br />STATE DI/ILDINI: ';URCIIARGf: <br />__—�� <br />STATE ENERGY SURCHARGE <br />AI• a.t',! It, <br />Ir'r ... •!•('rll {hFD Bt <br />�^. 1 <br />a1'I•II Ii1111•�•.Ili•. <br />PIIRI IC WORKS <br />TOTAL <br />PROPERTY "`WNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />