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APPLICATIC"I FOR CONSTRUCT"IN PERMIT <br />(* <br />TO BE COMPLETED IN BLACK INK --PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS XLECTRIC ❑ J <br />259-8810 <br />❑ DEMOLITION ye COMBINATION I J BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNE <br />M AIL ADDRESS <br />CITY 21P <br />PHONE <br />tye� E B1.srak <br />GT ft'ur7 BN�FRS <br />/�B <br />z'de / e rr �}'8ao3 <br />9 <br />9 % <br />TENANT <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />�i�PiafscQ.J <br />w <br />'rVe5/ 576/eitr}10' 9IIfae <br />Y <br />/;811-em 04vc. <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />SipmF' f}s <br />o �.de � <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE # <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE If <br />PLCMBIN'G CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE# <br />CONTRACT PRICE OF WORK <br />SCRIBEEWORKAND UAREFOOTA EIINVOLVED <br />CONT TP SONA HO <br />All— <br />lskI9a <br />"'2pel-Aaae <br />Al <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />p <br />pry/`E /fi/!� �T �q%%P'�i <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />4c,7 8 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCKOF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />n <br />�%i✓C/Yv{t�- p/!/.B %%L C'Tv0 <br />z1a. <br />vTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRICTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEHT, :0 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 />PARCEL TAX I.D. NUMBER <br />5 'D—d/A- 5� -omo_ <br />CONSTRUCTION LOAN LENDER. ADDRESS, TE P I ONE UBEFI <br />glI z Z <br />P OJEC/T AD/DRESS <br />Tu DATE <br />vt' O <br />CRY SINFSSLICENSE NO <br />PLUMBING <br />MtCHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />1 <br />A/C—A/HNDLG UNITS—H.P. <br />1 <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 />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />1 <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />T <br />1 <br />1 <br />1 <br />' <br />T <br />1 <br />SUB TOTAL $ <br />i <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />cno nccV`c IlQr nNl V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />�'� <br />RECEIPT NO. <br />/o ' <br />10'45'4-o <br />�2(o77 mar <br />G <br />o' <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />Frq1EE <br />BUILDING <br />TI-✓ <br />L�'. �� ) <br />1 <br />0Oo <br />❑YES ❑ NO <br />TYPE OF CDNST. <br />NO. OF STORIES <br />OXUpw <br />Ho. of 01YCl1IINGOITS <br />2 <br />GR P <br />PLUMBING <br />t <br />SIZE F B� <br />FIRE S°RINKLERS REO'D <br />B EMENT <br />MECHANICAL <br />l <br />❑ YES X NO <br />ADDITIONAL PLAN CHECK <br />/7 <br />,Y <br />OCCUPANCY LCAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />30 <br />No <br />� 4-�, <br />c�yJ' <br />~— <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF eVERETT <br />N <br />LOCAL SALES <br />DATE Q Z.T <� <br />TAX CODE IS 3105 <br />TOTAL <br />����Q <br />