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APPLICATIQ"'1 FOR CONSTRUCT"'')H PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rsr <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRlC ❑ <br /> 259•8810 <br /> U DEMOLITION ❑ COMBINATION I-! dUILDING I 1 MECHANICAL ❑PLUMBING ❑ SIGN <br /> OVINER M.11L 11DDRESS GTY ZIP <br /> PNONE <br /> Michael 6 Diane Wilton P.O. Sox 5155 Lynnwood, WA 98046 206-778-2166 <br /> TEN�NT MAIIADDRESS CITV ZIP pHpryc <br /> Central Welding Supply, Inc. 2530 Hewitt Ave. Everett WA 98201 206-259-2165 <br /> RFCNITECTORDESIGNER AUILADDHE55 dTY 21P PHONE <br /> GENER�LCONTRACTOR M�ILADDRE55 CITV ZIP PHONE STAiELKENSE• <br /> OWII!! <br /> MECHMlICA�GONTR�CTOR MRILADDRE55 CITY ZIP PHONE STQEtICENSE� <br /> PUIMBMGCONTR...,�OR M�R�DDRESS CIT'/ ZIP PMONE STATELICENSE� <br /> �C TRACT flICE OF WOiiK <br /> 12 500.00 <br /> . DESCflIBE WC9K ANO 50UAflE FOOTAGE INVOLVED CONTRCT PERSpN RNO PIqNE N0. <br /> Butld a 1200 s . ft. lwdln dock and concrete alab Sabs Luedke 338-3117 259-2165 <br /> atoraga +rea wiLh driveway approachea, inatall a 10 <br /> wide by 9' lall garaye door� sheet bullding front wiih <br /> : T1-11, inatall e type 1-L catch besin. <br /> ' i HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPQSEO USE OF Bi iDMO APPUCATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES QOVERNINO THIS TYPE OF <br /> � LEf3AL0ESCRIPTqNpFPROPERTY�SMOWNBELOWORATT�CHTWOCOPI..y WORK WILL B8 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> . , ���6,17.18.1��K 6901/2 � TGW THAT PTN VAC NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ' AUTHORITV TJ VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � DAKOTA AVE LY ADJ TO LOTS 16,17.18 6 19 OTHER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> i EVERETT DIV I PLAT OF BLK 693 D-00 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I CO PLY WITH THE STATE � <br /> ; PARLEL T�X I.O.NUMBER CONTRACTORS,�W 1B. AND 2 WAC. <br /> ! 4378-693-016-0000 � <br /> � CONSTRUCTIONIOANLENOEP,ADORE53,TElE%IONENUMBER <br /> -�� -9 <br /> I ppO,1ECT ADORqS s'°"" NE /153 °Aie <br /> � 2530 8ew3tt Ava. Evetett� WA 98201 Gn.���i�EH�� <br /> '" MECXANICAL <br /> � �N0. - TYPE OF fIXTURE OR ITEM FEE N0. TYPE OF EOWPMENT FEE <br /> I WA?ER CL ET(TOILE� � A/C--NHNDLG UNITS--H.P. , <br /> � BATHTUB ' FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS-B.LU. M ; <br /> � SHOWER � CLOTHES DRYERS � <br /> � KITCHEN SINK d DISP ; VENTILATION FAN ' <br /> � DISHWASHER � RANOE HOOD � <br /> i LAUNDRV TRAY ; WATER HEATER <br /> � CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ' METAL FIREPLACE(WO00 BURNING) ; <br /> ' DRINKING FOUNTAIN I FIREPLACE INSERT ; <br /> ROOR DRAIN � HEAT PUMP -�— <br /> � — <br /> i BACKFLOW PREVEfJTERS ; GAS PIPING <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> �� SINK(SERVICE-BAR,ETC.) ; � <br /> � <br /> � , <br /> T— <br /> � � � <br /> � � <br /> � <br /> T <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ � PERMIT S <br /> i <br /> TOTAL FEE S TOTAL FEE $ <br /> � FOR OFFlCE USE ONLY: <br /> i FRONT SETBACK REAR SETB�CK SIDE SCTB4CK PLAN CN K NUM1�BER FE �D RE��d0��� <br /> � 74 7a 7�� O <br /> � usezorie LOT�RER vnc�xrsre FEES VALUA710N FEE <br /> C' � ❑ YES . � NO I� � � <br /> BUILDING � � <br /> TYPE Of CONST r10.Of$TORIE$ aCuvANCY No Or DWFIUHG uNrtS i <br /> V../� � O1� PLUMBING <br /> SIZEOFBLDG. FIRESPRINKLERSREO'0 BASEMENT MECHANICAL � <br /> 'Z2� 'r. J. � [� YES L'�i NO � <br /> OCCUPANCY LOAD FIRE ALA^RM REO'D HEIGMT LIMITATION ADDITIONAL PLAN CHECK � <br /> NF1 A OTHER <br /> REASON � <br /> STATE BUILDING SURCHARGE � � <br /> INT�KEBY PIANSAP VEDBY CITYOFEVEREIT PUBLICWORKS � <br /> LOCALSALES <br /> o�re _ J, 5 TAX COOE IS 3105 �T�� <br /> / .SU <br />