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APPLICATIO.. FOR CONSTRUCTL _jN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 4aFff <br />BUILDING DEPART HEATINGHEATING SYSTEM: Q GAS Q ELECTRIC Q <br />259-8810 �%u z) /yla// /�yoc_ I: ay - <br />J DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING XSIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />_ Ii� 7UKE �-LN6F 406 SC 111 <br />wYQjo/ �y�zErl 9�2o9 ddo -y600 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />/ktC T141NE� U86 y06 5e66"7^ftLWV NJo/ EtafrrgPOI G6o-y6ao <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />RRM AIEoN IAC, P4TB� <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />6 69 _wAwoo� <br />CITY <br />ZIP PHONE <br />WR �9Yo G 776 3S B7z2LtNcod3CT <br />[IP PHONE <br />STATE LICENSES <br />STATE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />CONTPACT PRICE OF WORK <br />q � 90 � g y980.z <br />A. N Tom <br />DESCRIBE WORK ANP SOUARE FOOTAGE INVOLVED <br />Ns "x <br />CONTACT PERSON AND PHONEO <br />19L/D' a <br />M. GAYI.l 8'MPt Witm INr <br />c -Ns <br />�76-Sgss <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED <br />USE OF BUILDING <br />amme AoL <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANfES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF — <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 />PARCEL TA%I.D. NUMBER <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />vcHAruR - <br />P AFDDRE(.rS/S <br />/O�/JECT <br />M� <br />{/� s`• lo► <br />DAt <br />2 <br />CITY BUSINESS LICENSE NO. <br />!./yc='�/-�r�L�a� <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 />, <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />; <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />' <br />• <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />_ <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />; <br />SINK (SERVICE -BAR, ETC.) <br />, <br />I <br />, <br />SUBTOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PEF.MIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBE <br />FEE <br />30 <br />RECEIPT NO. <br />,$ 2/9/ <br />USEZONE <br />�-� <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONSi. <br />NO OF STORIES <br />oc, CVKY <br />nolry <br />No"'ME"nGUNItS <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RED <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />i <br />REASON <br />STATE BUILDING SURCHARGE <br />L ' <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />' <br />