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/ <br />/tcn,.T <br />Y OF <br />e,%ll-erett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICATION FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />_LEcATees 12 u u ti - <br />- <br />ANCHITECTORDECIGNER MAR ADDRESS CITY ZIP PHONE <br />GEN flAL CONTPACTOF. A/AILADDRESS CITY ZIP PHONE IICENSE• <br />i• <br />M�OHAMCAL CONTITACTOR /l LWL ADDLES, L CITY ZIP PHONE / LICENSE <br />CIpLLASE OF WORK R6PtJKCM <br />a NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSEHT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />�• <br />CONTRACT PRICE OF WORK T 4fJam% <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />.300o SF <br />CONTACT PERSON AND PHONE NO <br />tY <br />_ <br />PROPOSED USE OF BUILDING /j1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OPLAWS AND <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHET HER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br />WHETHER <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1B.27 RCW AND <br />296.200 WAG. <br />SIGNATUREO NTOACTOROn AU] ORIZEDAGENT DATE <br />X / / 1 /' <br />Al L ANISCITYBUSIN S LICENSE NO. AND BUSINESS NAME <br />l F.OAL DESCRIPTION OF PROPERTY (SIIOWN BELOW ORATTACH FOUR COMES) <br />LOT BLOCK OF <br />PROJECT ADORf.55 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />F <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNDLG UNITS -H.P. <br />_ <br />BATHTUB <br />1_ <br />FORCED AIR SYSTEMS- B.T.U. M EA <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />_ <br />RANGE HOOD <br />!.AUNORY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />- <br />_ <br />URINAL <br />METAL FIREPLACE& CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DFIAIN <br />HEAT <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS - RIdNLEADERS <br />✓ <br />EXHAUSTFAN <br />SINK (SERVICE - BAR, ETC) <br />SUBTOTAL 5 <br />SUBTOTAL $ <br />PERMIT 5 <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE & <br />FRONT SETBACK <br />REAR SETBACK <br />51DE SETBACK <br />FUN CHECK NUMBED <br />FEE <br />flECEIPf NO. <br />USEZONE <br />LOT AREA <br />VACANTSITE <br />FI YES ONO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />ALLOWABLEIACTUAL <br />OCCUPANCY GOOUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF SLOG. <br />NO. OF STORIES <br />BSMT. <br />O Y <br />❑N <br />OCCLOAD <br />MECHANICAL <br />.i <br />OTHER <br />FIRE SPRINKLERS REWIRED OYES ONO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR BY <br />--ZVI J <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />/ <br />/ <br />