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APPLICATIC J FOR CONSTRUCT. JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 4�ff <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />HEATING SYSTEM: U GAS )d ELECTRIC ❑ <br />COMBINATION XBUILDING <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />hIC"Zp WILY &,52Z C)L�(lJEJC_ nR- EUBIRL-nant qeyW3 <br />TENANT MAIL ADDRESS CITY ?IP PHONE <br />SIGN <br />ARCHITECT OF DESIGNER <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />1.L nL4,1 lL <br />fo• clanPv- <br />GENERALCONTRACTOR <br />MAIL ADDRESS CITY <br />LIP <br />PHONE <br />STATE LICENSE <br />L F oWIACIS_�d <br />P�CaL PTA `JTAhNAx77D U919 <br />fM= <br />387•�45 <br />JLIC20 234 G3 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING <br />MAIL ADDRESS <br />CITY <br />PHONE STATE LICENSE If <br />CLASS OF WORK <br />xNEW ADDITION AU ERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />✓ <br />L`(L.�� �4S <br />CONTRACT PRICE OF WORK <br />OL0VED <br />DESCRIBE AND SQUARE FOOTAGE,INFV4 <br />QWORK <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELO r YMR ATTACH FOUR COPIES) <br />11 <br />LOT A BLOCK o S <br />OT. THE GRANTING OF A HERMIT 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 WAG. <br />x �1�J?llc�c� 7-14 9z <br />S ATU DATE <br />N <br />' <br />PRWT A ECDDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />Q� <br />WATER CLOSET (TOILET, <br />/ <br />A'C—A/HNDLG UNITS—H.P. <br />. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNR-HEATERS—B.T.U. M <br />SHOWER <br />I <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />1 <br />DISHWASHER <br />( <br />RANGE HOOD <br />LAUNDRY TRAY <br />1 <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_I <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW FREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE—DAR. ETC.) <br />—� <br />T <br />, <br />SUB TOTAL $ <br />SUB TOTAL $ <br />— <br />PERMIT $ <br />PERMIT_ $ <br />TOTAL FEE $ <br />1 <br />TOTAL FEE $ <br />rvn v...va.. ...+� <br />FRONT SETBACK <br />USE 20NE <br />v..�.. <br />REAR SETBACN <br />?� <br />LOTAREA <br />SIDE SETBACK/ <br />VA CANT SITE <br />PLAN CHECK NUMBER EEE <br />3737 3 <br />FEES <br />n�� <br />"n J ` <br />VALUATION <br />RECEIPT NO. <br />FEE <br />BUILDING <br />PLUMBING <br />-7039q <br />--� <br />0 <br />� o <br />TYPE Of CONTS. ALLOWABLE <br />` <br />ig- <br />TYPE OF CONST. ACTUAL <br />GcCgIAvcv <br />Al GF PA'FLLING UNITS <br />MECHANICAL <br />�D <br />SIZE OF BLDG <br />1"MtjsF G <br />NO. OF STORIES <br />I <br />BASEMENT <br />A/O <br />ADDITIONAL PLAN CHECK <br />OCCUPAN Y LOAD FIRE SPRNKLERS RED HEIGHT LIMITATIO <br />G�JV� <br />REASO 'OR SPRINKLERS <br />SPRINKLER <br />STATE 131-11DING SURCHARGE <br />PUBLIC Worlds <br />D <br />INTAKE By <br />PLANS APPROVED BV <br />/2RQCO <br />2- <br />CITY OF EVERETT <br />LUtAL <br />TAX CODE IS 3105 <br />TOTAL <br />(p L13 <br />