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CITY OF C' NSTRUCTION r everett PERMIT PERMITNQ;- 20799 <br />259-8745 <br />❑ DEMOLITION ❑ COMBINATION 83 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CjY ZIP PHONE <br />The Premium Shop 305 SE Everett Mall Way Everett 345-15J2 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />Owner <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE II <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION 92 ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ BUILDING RELOCATION <br />VALUATION OF WORK <br />S 500.00 <br />DESCRIBE WORK <br />Tenant imp. <br />HEAT SOURCE <br />❑ ELECTRICITY ❑ GAS ❑ WOODSTOVE ❑ OTHER <br />PROPOSED USE OF BUILDING <br />Retail <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br />VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br />THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACT , AUTHORIZED AGENT, OR OWNER DATE 1 <br />X Er 'i $RHO Y <br />LEGAL DESCRIPTION OF PROPERTY ISHOW BELOW OR ATTACH FOUR COPIES) <br />LOT _ BLOCK _ OF <br />JOB ADDRESS <br />305 SE Everett Mall Way <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A C - AIHNDLG UNITS - H P. <br />BATHTUB <br />REFRIGERATION UNITS - H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS - B T. U.M.P. <br />SHOWER <br />GAS FIRED ABC UNITS - B.T U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS - B T.U. M EA. <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS -BT.0 L1 <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />_ <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC) <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />$ <br />SUBTOTAL <br />PERMIT <br />f <br />PERMIT <br />TOTAL FEE <br />f <br />TOTAL FEE <br />FRONT SETBACK <br />REAR SETBACK SIDE <br />SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE'.ONE <br />LOT AREA VACANT <br />51TE <br />❑YES ❑No <br />FEES <br />3UILDING <br />$ 500100 <br />15 <br />00 <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLINCUNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />MAX OCC LOAD <br />MECHANICAL <br />B SOH <br />Z.50 <br />FIRE SPRINKLERS REOUIRED ❑ YES CI NO <br />INVESTIGATION FEE <br />�Iel <br />STATE BUILDING SURCHARGE <br />3 <br />50 <br />STATE ENERGY SURCHARGE <br />APPLICATION ACC BY <br />S.H. <br />PLANS CHECKED RY <br />S.E. <br />APfR FOR ISSUANCE BY <br />B.E. <br />DRIVEWAY PERMIT <br />TOTAL <br />18 <br />50 <br />D RU.T VAI In ATInN <br />WHEN PROPERLY VALIDATED tIN THIS SPACE) THIS IS YOUR PERMIT <br />C) <br />C73 <br />c' <br />C. <br />N <br />Kt <br />ADDRESS FILE <br />