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D <br />APPLICATION FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ ELECTRIC U _ <br />259-8810 <br />Ll DEMOLITION LJ COMBINATION [,(BUILDING MECHANICAL PLUMBING ❑ SIGN <br />OWNER MLM1 ADDRESS CITY ZIP PNONE 2S_72 <br />till TIL MAM1.bDflE55 LRY 21P PHONE <br />L c EYJI ewe <br />MA R S 1 0.S� SIGif TZY/dYICR G1• �0'CaI 31�' 31 8 /eJdu <br />RCNITECi ESIGgcP M}IL AOD ES IfY P PNONC <br />nAn111Akv �_ P.. r 1� (�n0 Az P. , , 14 <br />TTYmon/ /ti 4om 3(0.3?8 <br />ADDRESS pU., n_X 733g7 <br />M A <br />yss73 �53-gyg�j <br />CF s C <br />STA1E p? <br />Ll LG <br />�lICENLEF � 11 <br />wP�q�^rFl <br />9 <br />TRALi <br />PRCE OF WDRN <br />0 3 <br />OE RI DE WORNANDSOUAREFOOIADEWOL%fD <br />CONTACT PERSON AND PNONE NO <br />(1.6YrL"pa Q U AWUAk LWv7vhIN`IvW <br />SLIM— 310. 328-(p30).) <br />IMJIN(AA hnAcllb�I <br />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 />CONTRRACTTORSLpW 18.27 RC�WAJND 296.200 WAC <br />1".6 TORF1E1 efo Er (' PeotAit_gLS�i� <br />Xxt IVY - <br />GN+Wf O if <br />vPOPoSED USEOOf BU) ���FI t AL <br />'rFAr,LVp' EnL-J1�11=— l LI <br />LEDALDESDRIPRDN OG Pf9PER1YISNOWNBELOW OR AIIAC11TVl000PlE61 <br />LOT BLOCK OF <br />PARCELTA% ID. NUMBER <br />CONSTRUCTION LOAN UNDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS I 02 4;V W(I1.1 <br />4ve�e.t� nAall a <br />CRYBUSNLSSLCEM5L <br />PLUMBING I <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 />I <br />AID-AMNDLG UNITS-H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M EA__ <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />UNITHEATERS-B.T.U. M <br />ROWER <br />THES DRYERS <br />HEN SINK&DISP <br />VEN TIONFAN <br />DIS SHER <br />RANGE D <br />LAUND TRAY <br />WATER HEAT <br />CLOTHES SHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (W BURNING) <br />DRINKING FOUNTAIAL <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADER <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />SUBTOTAL $1 <br />SUBTOTAL $ <br />PERI $ <br />PERMIT f <br />_ <br />TOTAL FEE $1 <br />TOTAL FEE f <br />FOR OFFICE USE ONLY! <br />FRONT SETBACK <br />REAR SETBACK <br />SOE SETBACK <br />PLAN C-ECKNUMBER <br />CCJJjj!! 5Xg17'— <br />FEE <br />RECEIPTNO. <br />I�SEIONE <br />LOT AREA <br />VACAMTUE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />SLIMING <br />PLUMBING <br />O <br />Z <br />IOO <br />aCf Bi t[NSf�� 11 <br />DIY <br />NJ. OF STORIES <br />I <br />m+I4p <br />GAov <br />tl4Mlllw MnS <br />mIEOFal <br />3 6/S <br />FIRESPRWKLERSREOD <br />gnING yl3 <br />BASEMENT 1! <br />❑ YES pl NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />cCCUPANLY LOAD <br />O <br />FIIR,ErAUPM REOD <br />HEKBRL9DATXW <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />i rjb <br />NIAKEBY <br />PUNSAPPROVEDBY <br />T� <br />CITY OF EVERETf <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBUCWORKS <br />TO' <br />svj 6z) <br />