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APPLICJ�TIZN FOR CONSTRUC7 .' N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rsr <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />259-8810 <br />1.J DEMOLITION L 1 COMBINATION I i BUILDING I I MECHANICAL I l PLUMBING f I SIGN <br />OWNEP MAILADDRESS CITY Z�p PIIONE <br />Hunrar Tnv 1507 Western Ave #204 Seattle 98101 623-3006 <br />TENANT MAILADDRE55 CITV ZIP PHONE <br />OESIGNER MAILADDRE55 <br />GITY <br />GENERALCIXJTRACTOR MAILADDRESS CITY ZIP PHONE STATELICENSE� <br />MECHMIICALCONTflACTOR MAILADDRESS CITY 21P PHONE STATELICENSEt <br />PLUMBINGCIXJTMCTOR MAILADDRESS CITY ZIP PHONE STATELICENSER <br />Robinson Plbu. 607 SE Ev Mall Way #26 Everett 98208 355-6171 ROBINP*272C2 <br />CLASS OF WORK <br />I 1 NEW CI ADDITION I-I ALTERATION ��-; REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT i J BUILDING RELOCATION <br />CONTMCT PRICE OF WORK <br />�ESCRIBE WORK Ml0 SOUARE FOOTAGE INVOLVE[ <br />Install fire sprinkl <br />PqOP0.5ED USE OF BUILOING <br />S-Unit Apt. <br />LECv1L �ESCRIPTION OF PROPERN (SHOWN BELOI <br />LOT BLOCK OF <br />fADORE55 <br />21 Federal Avenue <br />IMBING <br />TYPE OF flXTURE OR I' <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIY <br />FLOOR DRPIN <br />BACKFLOW PP.EVENTERS <br />ROOF DRAINS-RAINLEADEFS <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAHSETBACK <br />USE <br />LOT AREA <br />CONTACT PEPSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />COPIES) 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 1 COMPLY WITH THE STATE <br />CONTflACTOR:, LAW 18.27 RCW AND 296.200 WAC. <br />z �ec �� �/T�f�2. <br />SIGN�TIIHE --T OAT <br />SUB TOTAL $ ; <br />PERMIT $ <br />TOTALFEE $ ' <br />SIDE SETBACK PLAN <br />\ <br />VACANT SITC <br />�_ � .]{. L I�: <br />I F�LU.^;A �ly� � NO.OF STORIES <br />R'CT� � <br />OCCUPANCY LOAU FIRE SPRNKLERS REO'0 <br />YY� <br />flEA50N FJF SPRINKLERS <br />INTAKEBV PLANSAPPROVEDBV <br />occuvsxcr I noarowewxo�qrts <br />MEIGHT UMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX COJE IS 3105 <br />OF EQUIPMENT <br />FORCED AIR SYSTEMS-B. <br />UNIT HEATERS-B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPUICE & <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />E'.B <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TO7AL <br />TOTALFEE $ <br />FEE`� <br />% �. �� <br />FEE <br />„ <br />