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APPLICATIO 'FOR CONSTRUCTr ,)N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8810 <br />Ll DEMOLITION ❑ <br />HEATING SYSTEM: <br />L l BUILDING ( AMECHANICAL iy PLUMBING SIGN <br />CITY PHONE <br />liENANT MAIL ADDRESS <br />FEA <br />ARCHITECTOR DESIGNER 9 IL ADORES <br />CITY <br />Pg <br />' ZIP <br />n ZIP <br />�{•VOW <br />�j <br />��/� <br />PHONE , <br />PRO•.1 <br />_�q-3vr6O <br />IL_CITY <br />G NERALC ACTO MAI ADDRESS <br />R4W►,C�.4DITPOOR .IIQ�AwES$�.uk �SriP�3o41�rl�l <br />CITY <br />ZIP <br />g <br />PHONE STATE LICENSE) <br />ME ANICAL C NTRACTOR MAIL ADD 55 <br />CITY <br />21P <br />PHONE NSE <br />PHONE STATE LICENSE 1 <br />�Y�L=T2ITMF ta/�1N/4F4�lNL %30 <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />l53+AAUr <br />CRY <br />r� 07hON1D�wh <br />ZIP <br />98osz 8$3tiiati /y6TRITMII[.3GM <br />PHONE STA E LICENSE A <br />CONTRACT PRICEOFWORK <br />7D� •00 <br />DEC RISE W K AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />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 />LI <br />PROPOSED USE OF BUILDING - <br />�j)fij(Y ogo <br />LEGAqL DECRIPi ION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT S'• 3 BLOCK AAof 1N AJJN.k NN�T <br />OP PA-M1TS?4c.,E 94 <br />PARCEL TAX TO NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />-7-720 <br />sI qua, F9 LIVE . <br />CITYOjINESSLICENSE NO <br />PLUMBING <br />ECHANICAL <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 —A HNOLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M 12Oo a <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />NTILATION FAN <br />DISHWASHER <br />RANIC.E HOOD <br />LAUNDRY TRAY <br />ER <br />CLOTHES WASHER <br />I <br />E <br />URINAL <br />LACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />IN RT <br />NGASPIPING <br />FLOOR DRAIN <br />BACKFLOW PREVFNTERS <br />,,,,,, <br />ROOF DRAINS—RAINLEADERS <br />N <br />SINK (SERVICE —EAR, ETC.) <br />I <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />— <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />r —' <br />rvn vY wr v.+� <br />FRONT SETBACK <br />..••�• <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCEINKrN,O BER <br />FEE <br />PT 110 <br />UsEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TVPT OF CONST. <br />NO OF STORIES <br />OCCUPANCY <br />GPow <br />NO OF MELLING ONTS <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REDD <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />jw <br />DATE �f <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />