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APPLICATIC`-1 <br />FOR CONSTRUCT"N <br />PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE <br />PRINT <br />HEATING SYSTEM: ❑ GAS <br />❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION !" ! COMBINATION <br />BUILDING <br />J MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER f11� Chi <br />CUY <br />ZIP PHONE <br />;1.ADDRESS <br />a%IsDn„I �z� -,rAn+ <br />r).r -+t_ <br />' <br />wA 98�03 <br />355-873t/ <br />TENANT ^M. MAIL ADDRESS <br />/ry � <br />CITY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />¢ et�ir vrf7 1915 YY�&AL4"' <br />Si" fyriLc <br />6 WA 35 3 - 053/ <br />_0 <br />GENERAL COHT CTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE F <br />ME ANICALCONTRA TOR MA LADDRESS > CITY H2W PHONE STATE LICENSE( <br />��,L< ,�«�.4r� i,�� s S� spa>�� oar <br />PLUMBING CONTR TOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSER <br />Mli)iTZ�t <br />C T PRICE OF V{QRK <br />" O //� <br />DESCRIBE WORK AND SQUARE FOOUGEVINVOLVEO <br />CON T PE( ONf ID ONE NO. I�, <br />4FI() k,Im CIOI�iSpn-76N-555D <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 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />(� <br />7� (7yCe(,� <br />PROPOSED USE OF BUILDING <br />SFE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR TTACHTW CO PIE <br />Q , A <br />LOT— BLOCK OF <br />PAP,CTAKJ�D NOD J - _ O j <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT AD RE S / <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—A/HNDLG UNITS—H.P. <br />_ <br />BATHTUB____T <br />I <br />/ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —BTU, M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />T— <br />URINAL <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />' <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 />I <br />• <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />ene nerlCC I I= flNl V. <br />FRONT SETBACK <br />usE _ZONE <br />1 <br />REAR SETBACK <br />LOT AREA <br />7 5A .e : <br />SIDE SETBACK <br />VACANT SITE <br />7 YES `/.ENO <br />PLAN CHE-K NU FEE <br />FEES <br />, �� EO <br />VALUATION <br />RECEIPT NO�� <br />770 <br />FEE <br />BUILDING <br />PLUMBING <br />j �y 32cj <br />� <br />(Q <br />TYPE OF ONST. <br />_ <br />NO. OF STORIES <br />Z <br />MCUVANCY <br />BBP3 <br />MB OI DBTIUI UNDS <br />I <br />SID�EE OF BLDG <br />SZ Ars sF • • <br />FIRE SPRINKLERS REO'D <br />J <br />BA�SEMWyE � <br />T&-'IES ❑ NO <br />MECHANICAL <br />0 ' <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCYLOAD <br />N/A <br />FIRE ALARM REO-D <br />J <br />HEIGHT LIMITATION <br />OTHER <br />/ <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKEBV <br />PLANS AP ROVED By <br />DATE ILill y <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />1 <br />T12- <br />