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APPLICATIQ4 FOR CONSTRUCT'7N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: 'AGAS O ELECTRIC O <br />259.881D <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICALUMBING ❑SIGN <br />PHONE <br />APLNITECT0110ESK.NER MAEADDHESS CITY ZIP PHONE <br />P,c,erWesr Gene 3l6 SEEVar-a IMYLIIWN gRLoef 290.4(00(o Puserwt 161K(p <br />GENEAALCONlR MR ADOPE59 CTry LP PHONE BTAT Lx:ENSEF <br />LONTMLT PPKE OF WDPN <br />-� 298 sF of flax <br />u s <br />DESCRIBE NdiKu+gspu��e fOOTAGEINVQVEO <br />CONTACT PERSON ANDPNDNE ND. <br />•r A Tun.C— Silo tOf FF RII7xpkje A <br />I HEREBY CERTIFY THAT 1 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 />CONTRACTORKIIRCW AND 296.200 WAC. <br />Y.PROJECT <br />PROPOSEDUS Fe <br />LDum <br />� <br />LEDALDEECRIPTXWOFPROPERTYI UUt TTALK TVmtoPlEs) <br />LaT BLOpt of <br />PAPLEL TAXID.NUMBEP <br />9 I ^ 611 (0 Z <br />CGNGTPUCTIDNLOAN LENDER.AUDRE55. TELEPHONE NUMBER4Dross uer m;w w Zverd <br />ADDRESS� <br />LmeusAtssLuxsLw. <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 />ARC—JVHNDLG UNITS—H.P. <br />BATHTUB <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK B DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE BAR. ETC.) <br />SUBTOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE a <br />FOR OFFICE USE ONLY: <br />FRDNTSETBACK <br />REAP NETWK <br />SIDE SETBACK <br />PLAN CX NNUMSE <br />- <br />FEE <br />LENT <br />763 <br />L. �n,.1 <br />/3 SS <br />USE Za+ <br />LOTA'.EA <br />VA TSITE <br />FEES <br />VALUATION <br />FEE <br />�.-� <br />CIYES ❑ NO <br />BUILDING <br />Q�� a,— <br />TYPE a MNSL <br />NO OF STORESyu <br />a¢wlXr <br />mbPADIIXGMIR <br />I <br />c -4 <br />e <br />PLUMBING <br />6ME Di BIW. <br />FIRE SPRINKLERS REDO <br />EMENT <br />MECHANICAL <br />i <br />2 2 T <br />AV <br />❑ YES PrNO <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANC/rYLOAD <br />FIN- RM AEOD <br />HE*HTLMaATKTN <br />ND <br />J <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />WAKE BY <br />PLANSAPPAOVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />J <br />LOCAL SALES <br />TOTAL <br />WE <br />TAX CODE IS 3105 <br />