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APPLICATIC"' FOR CONSTRUCT!"N PERMIT <br />TO BE COMPLETED IN BLACK-IW—_PLEASE PRINT <br />BUILDING DEPARTMENT EA�T�INGSYSTEM-:LlS ELECTRIC O ---I <br />259-8810 <br />L l DEMOLITION 1 COMBINATION �( BUILDING, n }� f_7 MECHANICAL I PLUMBING Ll SIGN <br />OWNER `` (-IIR'Si.,(\JMAIL.0DRESS �0� NlukiIte� i�dry��'Llll ZIP R6L -3 PHDNE2o6-348-3430 <br />_Motif n <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE 11 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE II <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE t <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PUONE NO. <br />- _ +� <br />^ <br />353 -(os9lAbo <br />Two BAY •low <br />. 0 <br />1 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 Oh 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 WORT( FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON CTORS LAW 18.27 RCW AND 296.200 WAC. <br />- <br />PROFOSEDUSEOF BUILDING M4ic <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK L• Q OF -n0-- - <br />NF y (Gs Fr. QF LOT' (5 LF jS SI Qb <br />PARCEL TAX I. D. NUMBER <br />Li 33�,-C)oo _ OLS -02 7 <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />NSA <br />PROJECT ADDRESS <br />3804 Mul<mreO W4 W <br />9 20� <br />SCN.1TURE DATE <br />EUYUUSINESsSLCENSENo <br />PLUMBING I <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS—H,P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />T— <br />KITCHEN SINK & DISP <br />1 <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />�— <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FnUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />GAS PIPING <br />; <br />ROOF BRAINS—RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SLB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SE TRACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONST. <br />NO. OF STORIES <br />MUPWY NO IN VMILING UNITS <br />Gaogv I <br />PLUMBING <br />SRE OF BLDG <br />Zq S <br />i FIRE SPRINKLERS REGD <br />o <br />BASEMENT / <br />V <br />YES i NO <br />MECHANICAL <br />I <br />I <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD <br />FIRE ALARM SEC <br />HEIGHT LIMITATION <br />L(/) <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPRO'V1ED BY <br />j Fr <br />DATE IZ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />