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APPL ICIATIC l FOR CONSTRUCT' 1N PERMIT f <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT fl� <br />BUILDING DEPARTMENT L HEATING SYSTEM_❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />-1 DEMOLITION ❑ COMBINATION BUILDING MECHANICAL ,k-�LUMBING ❑ SIGN <br />OWNERCJ:��,,,&n 5CMN)'r WAILADDR' CITY ZIP PHONE <br />%s F.erMl>s 132-t%�wAve.SkH, in✓eAnCeC4 gogoi 3/0-Rzy-(03o0 <br />TENANTL-,Qrden fVVni/I CLMAIL ADDRESS CRY ZIP PHONE <br />e/BFxpreJs Pur"OS 13z'I PW-AflSaP. 0. Aovra,7re QA ?DSDI 3/el-3zB-(c3o0 <br />ARCHITECT OR DESIGNER MAIL ADDRESSEE/DRPJJ Pe/Mii'.f CITY ZIP PHONE <br />Ph/ii;p /h46Y�,rr V0 13ZT Porr,q,Q sdr.H. Tovia.we �Yp 9osiJ/ 3iD•32$- jp300 <br />GENERAL CONTRACTOR MAIL AODRESS CITY ZIP PHONE STATE LICENSEp <br />.0 MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSER <br />T <br />j PLUMSINGCONTRACTOR <br />OL <br />Y <br />MAIL ADDRESS <br />CRY ZIP PHONE STATE LICENSER <br />QL7 <br />CONTRACT PRICE OF WORK �' - C' <br />DESCRIBE ORKANDSOUAREFOOTAGE IVOLVED <br />, ZZ <br />'1 <br />1 <br />CONTACT PERSON AND PHONE NO. <br />2 - OV <br />&1an1t inn rID/ <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 L'.HETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEIMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAIN REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTICPI. THAT I AM AU i HORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />/C/��ONTRACTORS LAW 18.27 RCW AND 296.230 WAC. <br />Utarden 1I?Nota h1ILa <br />Y hln� �IAQOQ (DLIia .'-p-/AeY1"f q- 1-q L <br />PROPOSED USE OF BUILDING <br />( <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />_ <br />PROJECT ADDP.cMS[. y ,L1,.1 /� <br />WLA U <br />SIGNQI E ,rj'�'—�j BATE <br />GIN BUSINESS LICENSE NO. <br />PLJMDING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P.BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A.LAVATORY <br />(WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />7EENO. <br />CLOTHES DRYERSKITCHEN <br />SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOODLAUNDRY <br />TRAY <br />WATER HEATER <br />; <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />! <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />; <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT S <br />_ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETSAC.K <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />✓dti <br />FEE <br />REC°I'T NO. <br />USEZONE <br />LOTAREA <br />VACANTSITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />I <br />TYPE Orq � <br />-r�Y/ /ILY( <br />NO. OF STORIES <br />OLLLPPNC+ <br />c G <br />Na. OVBMUINGPNITS <br />SIZE OF BLDG. <br />Tl- <br />FIRES KLERS REOD <br />BASEMENT <br />❑ YES ;-Z-NO <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />1 <br />OCCUPANCY LOAD <br />FIRE ALARM AEC'D <br />7Pvl�J <br />HEIGHT LIMITATION <br />OTHER <br />' <br />REASON lYX f <br />STATE BUILDING SURCHARGE <br />INTAKE BY PLANS APPROVED BY CITY OF EVERETT <br />CJM LOCAL SALES <br />e l — — DATE i I TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />