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APPLICATIV.V FOR CONSTRUC7.ON PERMIT 8Tr <br />TIED IN BLACK INK —PLEASE PRINT <br />TO BE COMPLE <br />HEATING SYSTEM U GAS i& ELECTRIC ❑ Ly✓s fr I <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION I I COMBINATION '' BUILDING I MECHANICAL PLUMBING LI SIGN <br />CITY ZIP PHONE <br />--I�-- MAll A0DRE55 <br />` 1� <br />IiL Ii� <br />TT�� Cz � zf32 <br />p L) RIB r i <br />IIO <br />�JLOWNER <br />AI <br />MAR ADDRESS <br />OITY <br />AP PHONE <br />TENANT <br />TENANT <br />M <br />N <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />21P PHONE <br />�i _:LtilS_� <br />N <br />FFCi <br />y7 <br />GENERAL OONTRACTOy!Rt-� MAIL ADDREGS <br />CITYZIP <br />STATE LICENSER <br />PHONE � 1 <br />T 3 H Pw L f W 4 LLI S L 7 <br />TALI <br />/ L7U /LLiiit' -si.3. Smck�� <br />L! <br />13 LVb <br />21P PHONE TEL <br />F�q M <br />En 1­1 <br />Y/3O17 <br />MECHANICAL CONTRACTOR MAII, OGRESS <br />CITY <br />Z <br />L4 <br />CITY21P <br />PHONE STATE LICENSE � <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />I,'n•I <br />CLASS OF WORN <br />REPAIR <br />! DEMOLITION <br />i. WOODSTOVE/fRPL INSERT .BUILDING RELOCATION <br />H <br />NEW -Ji ADDITION ALTERATION <br />CONTACT PERSON PND PHOO. <br />l�� - �F`f.S. <br />y <br />/ �{- c <br /><ONT.aw <br />� ���/ � <br />.� 14c l`fR!» L! !LL <br />rJ <br />p <br />W <br />EOF WORK <br />CONTRACT PRICE OF WORK � 'TC 3 <br />INVOLVED <br />(� C <br />DESCRIBE WORK AND SQUARE FOOTAGE <br />oIZLyF r, %ZS <br />THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED EOF BUILDING <br />I HEREBY CERTIFY <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />FA <br />• 5-� Lp 4p ry2 1 L'V 1\�� I b'f' C- <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />OR <br />LEGAL DESCRIPTION OF PROPERTY ISMO BELOW OR ATFACHFWRCOPIESI <br />T- <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN <br />DOES NOT PRESUME TO GIVE <br />LOT `/' :Z.O BLOCK S % of - E/2 C i <br />NOT. THE GRANTING OF A PERMIT <br />OR CANCEL THE PROVISIONS OF ANY <br />AUTHORITY TO VIOLATE <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />J f <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />T <br />THE <br />OWNER WHICH <br />PROPERTY <br />KTHOER <br />ANDPERFORM <br />APPLICAOTIONISIS I COMPLY WITH STATE <br />CONTRACTORS LAW 118.27 RCW AND 296.200 WAG. <br />A <br />DATE <br />5'iGY E <br />/. <br />PRWE'CTADDRESS ` T� U <br />y-7L/ 3i/ /-^1\ <br />1- 4J <br />LIlECHA5ICAL5E N0. <br />MECHANICAL <br />FEE <br />c <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT <br />NO. TYPE OF FIXTURE OR ITEM <br />_-- <br />AIC-AHNDLG UNITS-H.P. ' <br />WATER CLOSET (TOILET) <br />� <br />!-i <br />E FORCED AIR SYSTEMS-B.T.U. M E.A. <br />1 _ <br />! BATHTUB <br />_ LAVATORY (WASH BASIN)qWA <br />_ <br />UNIT HEATERS-B.T.U. M ' <br />CLOTHES DRYERS <br />MAW <br />SHOWER <br />- VENTILATION FAN <br />KITCHEN SINK 8 DISP�— <br />� 1 <br />unurn...• •....- HEAT PUMP <br />'1 FLOOR DRAIN GAS PIPING <br />— s <br />Y, I tlNVn 1 l l tXMAUJI rNl <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USEZONE <br />2�1 <br />LOTAREA <br />Ng 07) <br />TWE OF CONTS-ALLOWABLE <br />TYPE OF C0NSI. ACTUAL <br />SIZE OF BLDG. <br />NO. OF STORIES <br />II�� sf aood. <br />Z <br />OCCUPANCYLOAD <br />FIRE SPRNKLERS RECO <br />INJ <br />nILl <br />S <br />lACANT sl?eVFEES <br />3 <br />x UpAxc <br />rm a <br />seouv <br />-7BASEMENTICAL�IJAL <br />PLAN CHECKHEIGHTLIMIT <br />TI�jERILDING <br />SURCHARGE <br />S APPROVED BY CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES .JP 5/IZlf" TAX CODE IS 3105 TOTAL <br />,906.6,3 <br />VALUATI01 <br />39 98d/ <br />S <br />NO. <br />39a <br />