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APPLICATIC I FOR CONSTRUCT--14 PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT cv�mTr <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL Cl PLUMBING 1 : SIGN <br />O�ER _ MAILADDRE5S CITY ZIP PHONE <br />�11er 5904 (�a 259- i S 2R <br />TENANT (� tM��,A{.I�LADDRE S n CITY ZIP PHONE <br />Qc�Csor. 1 7f7T 1 \IL -A \ 7P <ti a <br />AHCHIILGI UMULSGNER <br />MAIL ALYIRESS Q <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />SMN <br />MECHw fiC1: '.'Y•'''ATOA <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE# <br />o to nelr- <br />PLUMBINGCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE It <br />e%5f_11IP i1 <br />COIJ� asp <br />EJ1/RIFWORK^ <br />DC�1�1 Y�j�RK AND ARE: <br />1C <br />TAG'(B(I`N/VOLVED <br />nc2 <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATIO14 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 PROPERT`.' TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AN I OMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RC N 96.200 WAC. <br />-as <br />PROPOSED `uS'E.o�DuaBING [ 9 <br />'�K (nCl�� / <br />LEGAL DESCRIPTION OF PROPERTY JSHOW'NBBELOW OR ATTACH 000PIES) <br />,� St. C1 GLock �OF 5 <br />vi C `1'�LOf WL E; <br />0.NI r fAA Ic it W t07 L,3 0.11 9 ca rfeG" <br /># >'j 12 I <br />PARCEL TAX I.O.NII.IBER <br />6131 2 8 S -4 Ow.- oo08 <br />CONSTRUCTION OAN LENDE .ADDRv TELEPHONE NU <br />oWn� Z_ n4=�—7 <br />ER <br />PROJEC eDDRESS /� ,('� <br />�O.v ir)1P� ��- t 4efC <br />SIGNATURE DATE <br />CITY BUSINESSUCENSE 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 />A/C-AiHNDLG UNITS-H.P. <br />BATHTUB <br />LAVATORY (WASH BASIN) i <br />; <br />, <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M Z <br />' <br />; <br />SHOWER <br />' <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK & DISP i <br />i <br />VENTILATION FAN_ <br />' <br />_ <br />D✓ <br />DISHWASHER <br />RANGE HOOD ✓ <br />, <br />_ <br />LAUNDRYTRAY <br />_; <br />WATER HEATER A✓ <br />I <br />CLOTHES WASHER ✓ <br />�- <br />WOOD STOVE <br />I <br />T <br />URINAL <br />' <br />^ <br />METAL FIREPLACE (WOOD BURNING) <br />, <br />DRINKING FOUNTAIN <br />_ <br />FIREPLACE INSERT <br />, ' <br />FLOOR DRAIN <br />' <br />.'- <br />HEAT PUMP <br />� <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />, <br />SINK (SERVICE -BAR, ETC.) <br />a- <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />; <br />TOTAL FEE $1 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: �c/_ -).5 <br />FRONT SETBACK T <br />REAR SETBACK <br />SIDE SE}CY <br />PLAN CHECK NUM <br />RECEIPT NO <br />USE ZUN <br />- 1 <br />LOTAREq <br />bf O <br />VACANT SITE <br />$YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i� 0`1 <br />TYPE OF CONST <br />_ t iJ <br />NO. OF STORIES <br />2- <br />XXIJwxcv <br />/C li <br />NB.aOWFUIxG uxrts <br />t <br />PLUMBING <br />SIZE OF BLDG, <br />FIRE SPRINKLERS RECID <br />BASEM��JJ++T <br />t+7YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />r- <br />REASON <br />INTAKE BY <br />PLANS APPROVED BY <br />J+4— <br />DATE. <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 31 D5 <br />PUBLIC WORKS <br />I <br />TOTAL <br />