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APPLICATIC <br />1 FOR CONSTRUCT' IN <br />PERMIT <br />TO BE COMPLETED IN BLACK II1K—PLEASE <br />PRINTrr <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS <br />J ELECTRIC J <br />259-8810 <br />DEMOLITION 1 I COMBINATION <br />!-I BUILDING <br />I (MECHANICAL <br />PLUMBING SIGN <br />OWNER V/IL ADDRESSp <br />�UdZ �fkrf 6292 C�—S c Yr4c �Pi+A}ti,1.yc <br />—F <br />CITY <br />• /9d � 3 � <br />ZIP PHONE' <br />v�ua 6 t7/0 <br />T NANT MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />�D.tIAlLS SOS S-&ereI'l t <br />LL(• 41 E✓ere ff <br />jS3 <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />71" <br />ZIP PHONE <br />STATE LICENSEa <br />No)o 604 r 9:dIe-- m-1 • SC/ S_,e <br />sp eirk/a-.vd <br />WA •lBD3? Al? /7oa NocrHNP 6 910 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE# <br />CONTRACT PRICE OF WORK <br />n2i98 <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />��QQNTACT PERSON AND P��PpNE NO <br />N•(Sdd1l, f77 /2Q9 <br />DIET. <br />le ILD <br />Oto NAIL.-s // 8+g 177F <br />-- <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 />CONT 71AC ORS LAW 18.27 RCW AND 296.200 WAC. <br />a_ I , -9-93 <br />PROPOSED USE OF BUILDING 7 <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TA% LD. NUMBER <br />-p-oon 1 <br />CONSTRUCTION LOAN LENDER. ADDRES TELEPHONE NUMBER <br />PROJECT AD�yEySSS <br />IJy�p}/O,L -`-e!E-u//�/ <br />S A URE n�rz <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 />I <br />A/C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />1 <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />-- — <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />1 <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />T <br />SINK (SERVICE -BAR, ETC.) <br />' <br />I <br />I <br />I <br />— <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK N MBER� / <br />FEE_ / ^ <br />/JJ <br />RECE �O3 ^ <br />16/ <br />USE ZONE <br />AREA <br />VACANT SITE <br />FEED^SL/Y_TT(JT[ <br />VALUATION <br />FEE <br />G '�� <br />El YES NO <br />BUILDING <br />5 i ego <br />I <br />TYPE OF CONST. <br />NO. OF STORIES <br />SUNKS <br />GROUP <br />PLUMBING <br />SIZE OF BLDG <br />FIRE SPRINKLERS PEOD <br />BASEMENT <br />MECHANICAL <br />❑ YES rl NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REGD <br />HEIGHT LIMITATION <br />OTHER <br />lie— <br />REASON <br />STATE BUILDING SURCHARGE <br />' SG <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />om <br />LOCAL SALES <br />�— <br />DATE II/j(/cj3 <br />TAX CODE IS 3105 <br />TOTAL <br />