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APPLICATIC01. FOR CONSTRUCT"N PERMIT <br />TO BE COMPLETED IN BLACK INK --PLEASE PRINT <br />HEATING SYSTEM: GAS J ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />I - I DEMOLITION COMBINATION I BUILDING MECHANICAL CI PLUMBING SIGN <br />OWNED MAIL ADDRESS CITY ZIP PHONE <br />5L� ,_( (`-EY>,k, ft-, �O14 �ti�'J�c \��n �1'g�n <br />TENANT MAIL AD_qRESS I CITY ZIP PHONE <br />ARCHITECT OR DE SIGNE R MAIL ADORE CITY ZIM PHONE <br />16 l yQAl C TIIoCI,S 1KI <br />GENERAL CONTRACTOR MAIL D REi CITY ZIP PHONE STATE LICENSER <br />I <br />MFOHAINIC�i� <br />AALLCON�TTRRACTTOOR{-`�-}- MAIL ADDRESS CITY tlr 1n1nc a�^�c.�..ci.ac. <br />PLUM) (JLNG CONTRACTOR , MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AN(D�SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />I HERESY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />Q ni &Q.1n eO ( <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />_- <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOWOR ATTACH TWOCOPIESI <br />iz.cYl <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />Z — oF�%Lhn n� i�c ,i. <br />LOT BLOCK — <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCALS TAW 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 />n <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 ROW AND 296.200 WAC. <br />PARCEL TAX I D eER <br />CONSTRUCT(^N LOANLENDER. ADDRESS. TELEPHONE NUMBER <br />h <br />D"TE <br />PROJECT ADP ESS <br />� � . <br />S,CNkTu E ( <br />CIiV flU 14ESS ULENGE NO <br />T , <br />PLUMBING <br />MECHANICAL <br />_ <br />Wp, ' TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EOUIPMENT FEE <br />' <br />CLOSET (TOILET) <br />A/C -A HNDLG UNITS-H.P. <br />A.;ATOi <br />BATHTUB /�/ <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />�_? <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />J A <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGEHOOD _ <br />I <br />LAU14DRYTFI <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />- <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />_ <br />DF{NKING FOUNTAIN <br />FIREPLACE INiERT <br />__ <br />FL009 ORAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />-- <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />-' <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />F-UK urrit r uac <br />SETBACK, <br />SETBACK <br />un": <br />BEAR SETBACK <br />BEAR SET;;�� <br />SIDE SETBACI$ / <br />PLAN CHECKNUMBER <br />FEE <br />RECEIPT NO <br />FRONT <br />FRONT <br />� <br />� <br />USE ZE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />33 /(/ <br />�f <br />/ <br />❑ YES El NO <br />TYPE —OF CONNSST( <br />NO. OF STORIES <br />DXUPANn N°aM LLINGIMIn <br />°N�. I <br />PLUMBING <br />Q <br />o <br />MECHANICAL <br />/� 1 <br />' <br />SIZE OF BB��OG.r� <br />FIRE SPRINKLERS RED <br />SAFFSE.M3 <br />L,&20 JF 6A2 <br />/�u <br />I_ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY L AD <br />A <br />FIRE ALARM REOD <br />J <br />HEIGHT LIMITATIOy. <br />OTHER <br />_t <br />T <br />REASON <br />STATE BUILDING SURCHARGE <br />��� b <br />PUBLIC WORKS <br />PLANS APPR VE av CITY OF EVERETT <br />INTAKE 8/ <br />LOCAL SALES <br />TOTAL <br />2 <br />DATE S�cj yy TAX CODE IS 3105 <br />, , <br />7 <br />