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APPLICATI04 FOR CONSTRUCWDN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />I HEATING SYSTEM: ❑ GAS ❑ <br />ELECTRIC <br />J <br />259-8810 <br />DEMOLITION <br />COMBINATION BUILDING <br />MECHANICAL <br />PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />Zlp <br />PHO14C <br />GJQr/(�l�IrIC_ <br />N.fi'Z I`/ <br />�� <br />I cy �(--li /G "'7(Gi4%`)(� <br />,,� / <br />WA 28(oI <br />�/��j <br />&0 f-�(ee:) <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CA1 f&)A d-114 <br />(CIA 17+5 <br />1147i4 AV- 5G KE <br />EuE <br />�0004 <br />',S%S <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />�d.fNf (Lu <br />�(yI Iti1�JL1(L�'J�S <br />If5`f5S <br />UL/MF'fc �vs l7 <br />lUKwiLp <br />lS�/gGY� <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />MLUMNIGAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE+ <br />L NEW ADDITION ALTERATION REPAIR DEMOLITION wnnn4TnvFiFool InlccoT o„I, n,.,.. mi I <br />2 <br />CONTRACT PRICE OF WORK J - S�C . Oa' <br />UESCR19E WORK AND SQUARE FOOTAGE INVOLVED P_EGOv%YL E:�liZ xw,vix f. <br />ADD PEAK CANOPY 4 )N5-7suL c�461/ jF_'7 Sf<(4 12,1 <br />CONTACT PERSON AND PHONE NO. <br />_ I _ oo <br />- <br />PROPOSED USE OF BUILDING <br />i <br />1 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X ��Z ma <br />LEG AL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK of <br />3Q_:i MA:-LL Y <br />PROJECT ADDRESS <br />SIGNATURE 6L-3% 3 /- LATE <br />try <br />CITY BUSINESS LICENSE NO <br />PLUMBING <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 />A'C—A,HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />i <br />CLOTHES DRYERS_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />' <br />CAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT $ <br />TOTAL FEE S. <br />TOTAL FEE $ <br />ISE ONLY: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />- <br />FEE <br />RECEIPT I.O. <br />a <br />a <br />i/ <br />s WTAREA AA,, <br />VACANT�SIITE <br />- <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />� <br />(Z'Iw1RAL- <br />"' <br />E <br />TYPE OF CDNSi. ACTUAL <br />ttcu1Aac1 <br />xo BE BWFUINGuxliS <br />caouP <br />PLUMBING <br />NO. OF STORES <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />FIRE SPRINKLERS REO'D HEIGHTL,MITATION <br />IRS <br />SPRINKLER <br />i <br />STATE BUILDING SURCHARGE <br />I� <br />APPROVEDBV <br />CITY OF EVERETT <br />PUBLIC WORKS <br />TPL <br />LOCAL SALES <br />l .a j 'S <br />TAX CODE IS 3105 <br />TOTAL <br />Qa SX <br />