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APPLICATIC A FOR ICONSTRUCZ .ON PERMIT <br />i0 BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS <br />'ELECTRIC iJ <br />BUILDING DEPARTMENT <br />259-8810 <br />�� —�1F1� <br />DEMOLITION <br />i I COMBINATION BUILDING <br />MECHANICAL PLUMBING SIGN <br />H C) F <br />L'I <br />OWNER <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />H3 <br />y`[l� <br />2L3o.Gay1r twb M?AA <br />taltwAac dA yeg4?1 /4 - 2z -3 <br />0 <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />TENANT <br />H <br />H .r� <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP PHGNb,B,.y,� <br />(lt1NwC�iVJA �L•O%1L'i���..-L <br />K n <br />57�8i� ltJt. <br />301r�- r—_� <br />— <br />ZIP PHONE C STATE I CENNSE� <br />I-3 w <br />GENE ALCCWTRACTOR <br />MAIL ADDRE55 CITY <br />0=0 <br />sJ US <br />� <br />MEONANIC ---]ONTRAAC�TOORR MAIL ADDRE55 <br />CITY ZIP <br />PHONE STATE LICENSER <br />,[["Jo <br />STATE LICENSE <br />HOi d <br />PLUMBING CONTRACTOR MAILADDRESS <br />QTY Zlr <br />PHONE <br />O H <br />HIm <br />CLASS OF WORK <br />e— <br />YIya -� c aw <br />n� O <br />1 NEW I I ADDITION 17 ALTERATION <br />EPAIR DEMOLITI N V <br />OODSTOVEIFRPL INSERT 1.1 BUILDING RELOCATION <br />CONTACT PERSON AND PHONE N0. <br />CONTRACT PRICE OF WORKLZ o"S" <br />DESCRIBE WORK AND SOUAR FOOTAGE INVOL D <br />�- 2ao� 'C"Cacz>F <br />_ o Zo <br />PROPOSED USE OF BUILDING <br />I HE EBY CERTIFY THAT I HAVE READ AND EXAMINED HIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINGi HIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERIV (SHOWN BELOW OR ATTACH FOUR COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEF:EIN OR <br />LOT BLOCK OF <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 AIJD 296.200 WAC. <br />PROJECT ADDRESS <br />sGN ue DATE <br />/y4 � J-E E UT .M,e[c C✓y <br />CRr RUSINESS LICENSE NO <br />PLUMBING O <br />MECHANICAL O %.1 <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEV <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRYTRAY <br />' <br />WATER HEATER <br />' .- <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE & CH NEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREV ERS <br />i <br />GAS PIPING <br />ROOF DRAIN AINLEADERS <br />I <br />EXHAUST F <br />' <br />SINK (SERVO —BAR, ETC.) <br />i <br />I <br />' <br />I <br />I <br />� <br />1 <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />_ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTALFEE $ <br />' <br />...6 FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REARSETBACN <br />SIDCSETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />L 7 <br />USEZONE <br />LOT AREA <br />VACANTSRE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />W <br />-2' 00 <br />TYPE OF LDM'AllOWABIE <br />f-oAACiuAI <br />�uW <br />IBASJ <br />NO aox'FL uxlrs <br />r(7 <br />SRE OF BLDG.11++j}�IPE�h�` <br />N•-OfLLTO'F STO'•RVI/EB <br />BASEMENT <br />uo <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />, <br />i <br />� 4z'1 <br />2 <br />OCCUPANCYLOAD FIRE SPRINKLERS REOD HEIGHT LIMITATION <br />H lis�J <br />SPRINKLER <br />� <br />_ <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />I <br />I S <br />INTAKE BY <br />^CANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />2 2 BIZ )ii i <br />TAX CODE IS 3105 <br />TOTAL <br />Iv <br />