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APPLICATIC 1 FOR CONSTRUCT --IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: p GAS ELECTRIC J <br />259-8810 <br />1 DEMOLITION Ll COMBINATION ;-"BUILDING MECHANICAL ❑ PLUMBING ':1 SIGN <br />OWNER /I MAIL ADDRESS <br />�,-gHtc /yam 5� CITY PQE✓C✓ M411w4y , TENANT <br />ovve7 y 1, /AILOAO�RES 6vr✓e�l A d I4/ ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY/ ZIP PHONE <br />h <br />5 <<14 IatArs 1�s�XwS <br />Cz�) 6ze2-6oS6 <br />GENERALCONTRAC`TO'R 11 MAIL ADDRESS <br />i �di;E_ <br />�,LCIITY <br />ZIP P'H'OtN <br />STATE LICENSE <br />/V q MW �a� KC <br />o� �c <br />6 41K JTft� W <br />Q� <br />MECHANICAL NTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />STATE LICENSE N <br />PLUMBING <br />ILDNE63RR <br />CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE-�✓IIJ! <br />STATE LICENSER <br />CON <br />1 <br />RACT PRICE OF WORK <br />6wo <br />DE RIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE <br />S% t'pric5.( IAJ,?I( bory K" 5 <br />evpm <br />1 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 LAW 18.27 RCW AND 296.200 WAG. <br />u ,E 1 JI <br />is IFS _` V ' 7l 1// 1v <br />slcNATRE S] DATE <br />E tD usE`F BUILDING <br />•�,E <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 />PROJECT ADDRESS L!►pe <br />IL4O KywMeell <br />CITY BUSINESS LICENSE NO <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 />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK d DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />' LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />59aco5 <br />FEE <br />1S/.35 <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />; OD <br />TYPE OF CDNST <br />zA 1 <br />_Lf�v <br />NO. OF STORIES <br />I <br />acuvxxcv <br />ROMP <br />NO Br mvfulxsuurts <br />PLUMBING <br />' <br />' <br />SIZE OF BLOG. <br />+'M '-t• <br />4 <br />FIRE SPRINKLERS REO'D <br />It-* <br />BASEMENT <br />❑ YES X NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />l�3 <br />FIRE ALARM REO'D <br />YiF <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />✓iv��jlG' /"fill�l <br />STATE BUILDING SURCHARGE <br />; s� <br />INTAKE BY <br />PLANS APPROVED BY <br />IJM <br />DATE ; ,y <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />SL <br />