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H <br />JD <br />9 H !~i� <br />HEX <br />o�oHC+�tl <br />�1 H <br />rpH� <br />x <br />lOY O v <br />/MR8 <br />ZH <br />Y/ w <br />C" H I <br />C" H H <br />O d CA <br />O CA <br />APPLICATIC I FOR CONSTRUCT"3N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: dGA.S ❑ ELECTRIC ❑ _ <br />259.8810 <br />DEMOLITION ✓ COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />ItosewT III RAodpA"so 1So8S "w-RT sr. 0F2oE ftuAwrL, WA. aaoos 44-oswea (w) WO-OSStu (Af) <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE * <br />?4FAItTdWoov I,"IES P.O. PS.ic 29FS5 LYAL.Iwo=, wk. 95ow 771.1141t f/E4 <br />a7W#)joai <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE* <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />PHONE <br />CLASS OF WORK <br />✓NEW ADDITION I I ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT RI In nlNn, RPI ncATInN <br />(7�7[C` GD % <br />CONTRACT CONTRACT PRICE OF WORK rl{O,DOOL <br />CONTACT PERSON AND PHONE No - <br />RosMILT Rao 44,1'oswi <br />DESCRIBE WORK AND SQUARE FOOTAdL INVOLVED <br />flew 17;s $o. Fr. SPEC. HousE <br />PROPOSED USE OF BUILDING <br />slo-lgtG FA4my usicei/c6 A R-S ou+IInPI oY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION At KNOW THE SAN E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS A"ID 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 1 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 />x_/,Qx U-29.92 <br />LEGAL OF SCRIP TION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK of <br />A77AC AP <br />pp / <br />3o 04t irloic /J�Jo�_ <br />PROJECT ADDRESS I <br />7bK A%Sj,;,djo <br />SIGNATUBF VAN <br />CRVB,.,SSLWFNSP. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />Oj <br />WADER CLOSET (TOILET) <br />AC —A HNDLG UNITS—H. P. <br />1 <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />4� <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />I <br />SHOVER _ <br />I <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK 8 DISP <br />b <br />VENTILATION FAN <br />I <br />DISHWASHER <br />1 <br />RANGE HOOD <br />�— <br />_LAUNDRY TRAY <br />I <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />I <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />I <br />GAS PIPING <br />' <br />_ <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />L <br />SINK (SERVICE —BAR. ETC.) <br />; <br />I <br />G <br />Oi <br />I <br />I <br />I <br />i <br />I <br />I <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT S <br />i <br />TOTAL FEE $ <br />' <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: 357. Ig <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK TA- <br />3S'nPne <br />PLAN CHECK NUMBER <br />2 7 <br />PEE <br />zo, <br />RECEIPT N:T <br />USEZON& <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEES <br />2.6� <br />BUILDING <br />I- <br />iYPEDELCNTS. ALIOWABtE <br />TYPE fCONST ACNAL <br />BcarANcv <br />NB pBwmINC UMR <br />i <br />L� <br />�p 3 <br />PLUMBING' <br />SIZE OF BLDG <br />I"!4l Sf <br />_ <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />�()�� <br />L <br />O <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD FIRE SPRNKLERS RED D HEIGHT LIMITATION <br />SPRINKLER <br />REASON OR BPRINKLEflS <br />STATE BUILDING SURCHARGE <br />—T�— <br />41160 <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />J <br />j <br />LOCAL SALES <br />09 9 <br />TAX CODE IS 3105 <br />TOTAL <br />