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APPLICATIO"' FOR CONSTRUCTI _'N [HERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: J GAS <br />❑ ELE"TRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />`-ig-UILDING <br />A MECHANICAL L PLUMBING <br />Li SIGN <br />OWNER MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />�aN j90611isom <br />F! F�"e.N� H <br />91"/ <br />TENANT MAIL ADDRESS <br />CRY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP <br />GENERAL CONTRACTOR MAIL ADDRESS /,y CITY ZIP PHONE STATE LICENSE <br />/�ACiri C 61yY�en6c iAlc_ 6/�Cc' �`:.sCYC aLS,(e& 98P0/ Al P-131/ c138?A) <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />(o$I//OJ . f p - <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONT T PERSON ANO PHp N0. <br />�✓ NE NE G 9- <br />S y6 5 <br />I 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 PREFUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVVAONS 0= 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X s <br />SIGNATURE B - <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT /7 BLOCK OPS-00 C: -_ �&e- C�f" h,,p/je/ <br />PARCEL TAX LD. NUMBER GC <br />CONSTRUCTION LOAN LEI:DER, ADDRESS. TELEPHONE NUMBER <br />PROJECT AL.'=Ecc-1 /r <br />a''7 _'j./ <'�� C�i <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />T YPE OF FIYTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TCILET) <br />( <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />- <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />I <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT S <br />PERMIT $ <br />�- <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FAR OFFICF I IRF f1Nl V. <br />FRONT SETBACK/ <br />REAR SETBA> <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />usE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />— <br />❑ YES ❑ NO <br />TYPEOELONST <br />NO. OF STORIES <br />OCCUPANCY <br />NGOEGWUINGUNITS <br />-N <br />I <br />GROUP <br />I I <br />PLUMBING <br />i <br />-T <br />SIZE OF B.DG. <br />FIRE SPRINKLERS REO'0 <br />BASEMENT <br />MECHANICAL <br />1 <br />57,60 i5ral. <br />I vo <br />❑ YES Ll"NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCYL AD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />O <br />z I <br />1 <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED By <br />LNJ <br />CITY OF EVERETT <br />PUBLIC WORKS <br />J <br />LOCAL SALES <br />DATE G �J % <br />TAX CODE IS 3105 <br />TOTAL <br />