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APPLICATI�1 FOF; CONSTRUCi'I�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATWG SYSTEM: ❑ GAS ❑ ELECTRIC ❑ � <br />259-8810 <br />CI DEMOLITION iJ COMBINATION I i BUILDING i�MECHANICAL [-1PLUMBING �_, SIGN <br />OWNER l.1AILFO�RESS CITY ZIP PNONE <br />�i'ZLL �iCf> so�• /Yd.i S,S- i��. ,c.ii.cc wrrt� �"v, W��• `7X.e�.-'/ <br />TENANT �AAILAD�RE55 CITV 21P PHONE <br />✓lil � � Z �L S /�/o,L SJr_ �v •.�-Li� G� c��� � � �. u/i�. 9�.te J <br />ARCHITECTORDESIGNEF MAI�AO�RE55 CITY ZIP PHONE <br />GENEFAL CONTRACTOR MAIL AO�RE55 CITY ZIP PMONE STATE LICENSE u <br />�(�/,a �Z/'� d .S�tr<ty .ZO,L.Z /.3•Po.�.�c.�i�y /v, w/f 9X.to� .25: �S�.i3 <br />MECNANICALGONTRACTOR MAILA��RE55 CIN 21P PHpNE STATEUCENSEa <br />,��n�vf� i�i �.� <br />PLUMBING CONIRACTOR MAIL ADDRESS CITY IIP PHONE STATE LICENSE i <br />�X%y.C,[S ✓-...' /95 y <br />CONTRACT PRIGE OF WORK <br />7 , i , . _� <br />OESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />� <br />PROPOSED USE OF OIIILDING <br />CONTACT PERSON AND PHONE NO <br />SCa� �i'dOi�..� <br />S�i�!c�..n S��— / il 7 c— <br />LEGAL DESCRIPTION OF PROPERiV (SHOWN BELOW OR ATTACN TWO GOPIES� <br />LOT BLOCK OF <br />PARCELTAXID.NUMBER <br />CONSTRUCTION LOAN LENDER, <br />NO. TYPE OF FI%TURE OR <br />WATER CLOSET (TOILET) <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK ISERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FRONTSET��CN REFRSETBACN <br />USE ZONE <br />TYPE OF CONSi <br />SIZE OF BLDG <br />OCCIIPANGYI <br />REASON <br />INTANE BY <br />LOT AREA <br />NO. OF STORIES <br />� <br />� <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />SIDE SETBACK <br />VACANT SITE <br />❑ YES f=� NO <br />anmaxcr xoo�mvEuixcuvrts <br />r,9oUv <br />FIRE SPHINKLERS flE0'� <br />R@O � <br />PLANSAPPROVEDEV <br />J111 <br />OAIE /il���l�i <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THI� <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORAECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL 8E 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 CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PAOPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOAS LAW 18.27 RCW AND 29G200 WAC. <br />X J `..�—�-�__ G :Z P—» <br />siciuume oeie <br />urv ouswcss ucense r+o � <br />MECHANICAL <br />PLAN <br />�F EQUIPMENT I FEE <br />A/C—AiHNDLG UNITS—H.P. <br />fORCCD AIR SYSTEMS—B.T.U. M E.A. <br />UNITl1EATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HFATER <br />WOODSTOVE <br />METAI FIfiEPLACE (VJOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />FEES <br />BUILOING <br />PI_UMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />STATE BUILDING SL'FiCHAP,GE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE 5 <br />FEE REC i NO. <br />2U °`'— 7� <br />O�I <br />d'J <br />