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ems_... <br />APPL.ICATIC J FOR CONSTRUC1 3N PERMIT 'r <br />- s< TO BE COMPLETED IN BLACK INK —PLEASE PRINT 1 cvE/'x <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ _ <br />�yG <br />p A H <br />r q OL <br />K <br />A <br />r� <br />b N M <br />ro O <br />H •7 <br />(~]R <br />p <br />H <br />H h1 <br />i <br />t� I -I H <br />O En <br />RL7En <br />yea <br />jTn <br />0 v <br />I <br />BUILDING DEPARTMENT <br />269.8810 <br />El DEMOLITION <br />❑ COMBINATION BUILDING <br />❑ MECHANICAL_ 0 PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS CITY <br />6WOR 146 9000 VMLOct 816 <br />MP <br />�15o <br />INO . <br />IALlPoZARC-MiL M(2 *10'7 <br />NTmosnmE <br />MAL. IDRESS CRY <br />)Ar-5375 E NUATePL Me. AUANEIT , cA.— <br />ED <br />920ol <br />ARCHFECTOR DESIGNER <br />MAILADDRESS WIT <br />►52h 'f*' Qe CARRDU rOM <br />ZIP <br />117; As <br />PH�E n/_n/I. <br />'157O 1 4) %-46LI -4 <br />c.o. KogLof- <br />GENERAL CONTRACTOR MAILADDRESS CRV <br />.1 n.....NJ� Illoid h�� /�AJ GL� <br />ZIP <br />/ PHONE `�n1�TATE LICENSE <br />rwo44lo 2 — <br />N I� Vr-.1.. L fvILI` - - - — <br />CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE A <br />WORK k _ _ _ - r-1 n...nl IfInra 1-1 Wnnnsrnvc/FRPL INSERT ❑ BUILDING RELOCATION <br />LI NtVV LJ HUUI I IVIY <br />/, <br />CONTA NAND NO. �'27-Zllr/� <br />CONTRACT PRICE OF WORK '`� D O <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />OC�Mt L. <br />G14n9 �� s.�. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />ILDIN <br />PROPOSED USE OF BUG <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />L S � <br />PROVISIuNS OF LAWS AND ORDINANCf.S GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED W118 VNIRtHER SPECIFIED HEREIN OR <br />LEGAL DESCBIPTIONOF PPOPEBTYISHOWN BELOW OR ATTACH FOUR COPIES) <br />OF <br />NOT. THE GRANTING OF A PERibli DOES NOT PRESUME TO GIVE <br />LOT BLOCK <br />AUTHORITY TO VIOLATE OR CAIICES. THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCT10; 1. THAT 1 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 WAC. <br />1212 3 ? 4 �-'qnAtv -9�-- <br />WAY. <br />PROJECT ADDRESS <br />_ <br />LIB.. LNW1 <br />PLUMBING <br />M. 'CAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 C NEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENT S <br />i <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAI EADERS <br />I <br />EXHAUST F <br />SINK (SERVICE— AR, ETC.) <br />_ <br />� <br />I <br />— <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $I <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />rum urrH.0 VJC <br />FRONT SETBACK <br />�— <br />USE ZONE <br />— I <br />VHLT4 <br />REAR SETBACK <br />LOTAREA <br />SIDE SETBACK <br />VACANT SITE <br />A0 <br />PLAN CHECK NUMBER FE 0.3 <br />7765 �lo <br />FEES VALUATION <br />flECEIPT NO. <br />�y09L <br />FEE <br />BUILDING <br />PE OF CONIS. AUI VABIE <br />TYPE OF CONST. ACTUAL <br />M0. abA411M UNIlA <br />PLUMBING <br />' <br />—*— <br />I <br />RE OF BLDG. <br />60 Sn GT <br />NO. OF STORES <br />I I <br />W EW <br />MECHANICAL <br />1� <br />ADDITIONAL PLAN CHECK <br />`I— <br />C .C{1PAN�LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />I �PPTT N O <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />i <br />STATE BUILDING SURCHARGE <br />! �j <br />v <br />PUBLIC WORKS <br />y <br />INTAKE BY <br />PL:TFIOVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />1 <br />I <br />