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TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O N. A. <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION L� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL ADDNE55 CITY 21P PHONE <br />Housing Authority of the City of Everett, 1401 Poplar, Everett, WA 98201 258-9222 <br />7ENANT MAILADDRE55 CITY ZIP PHONE <br />Same <br />ARCMITECTONOE516NER MAIIADDRESS CITY ZIP PHONE <br />CNJJ Architects, 2722 Colby, Suite N607, Everett, WA 98201 259-1560 601-291-582 0 <br />GENERALCONTMCTOR MAILADDRESS CITV ZIP PHONE SUTELICENSE� <br />t1ECMANICALCONTHACTON AUR�DDRESS CITY ZIP PHONE ST�TELICENSE/ <br />PLUAIBRqCONTRACTOR MAIIAC�PESS CITY 21P <br />CONTMCT PR�CE OF WOXK <br />OESCqIBE NqpK AND SOUARE FOOTACE INVO�VED <br />PlqNE STAiE UCENSE 1 <br />Q <br />existin Community Building, for handicap <br />arrocei�crr... Mike Nickerson (CNJJ Arch.l 259-1560 <br />PROPOSED USE OF BUILDING <br />Lew—Incnme He��ein <br />LECvLL DESCRIPTqN OF PNOPEHTY �SHC <br />LOT BLOCK - <br />(See Attached) <br />PARCELTN(I.D.NUMBER <br />CONSTM1CT10N IOAN LENOER. ADDIiES' <br />PRQIECT ADDRESS <br />�uni a�p�a.- <br />PLUTABINO <br />NO. TVPE OF FlXTI <br />WATER CLOSET (TOIU <br />BATHI UB <br />LAVATORY (WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />- DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />I HEREBY CERTIFY THAT I HAVE FiEAO AND EXAMINED THIS <br />APPLICAT�ON AND KNOW THE SAME TO BE TflUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />BELOWORATTACHTVIOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />—�F AUTHORITY TO VIOIATE OH CANCEL THE PROVISIONS OF ANY <br />/AX �' 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 PEFFORM THE WOHK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />'�.LEPt10NE NUMBER � /�.,�,� / � / • � / a,� <br />���ti ��:�On� 6—�Y93 <br />�"""mc027521 o.re <br />CIIY BUSWE55 LKENSE NO <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONTSETB/�CK RE�RSETB/�CN <br />IYPE Of LONSI. <br />6iZE OF BLW. <br />( oo S <br />OCCUPANCY LC <br />2�_ <br />PEASON <br />INTANE BY <br />LOT AREA <br />SUBTOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />SICE SETB�CK <br />FIRE SPRINNLERS NEG D <br />r . N' <br />FIRE ALAPM REO'D <br />.v o <br />� <br />DA7E � . I�'�� <br />FEE I N0. I TYPE OF EOUIPMENT I FEE <br />A/C—/VHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE I <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUST FAN <br />S <br />TOTALFEE S <br />NUMBER <br />0 <br />❑ YES ❑ NO BUILDINIi � / ' I,J <br />mw�x,.'r xo.vV.�[uixcun'ts i <br />wa1P PLUMBING i <br />15EMENT MECHANICAL ' <br />� YES ❑ NO � <br />EICiNTL�MITATqN A�DITIONAL PLAN CHECK i <br />� <br />OTHER � <br />STATE BUILDING SURCHARGE � � � l� <br />CITY OF EYERETT PUBLIC WORNS � <br />LOCALSALES <br />TAX CODE IS 3105 T�TA� /�%� ��� <br />