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H C)H <br />C H <br />9 H CA <br />HE% <br />HC 0 <br />H �1 <br />CA <br />rn H <br />HG <br />b7 O <br />OHb <br />Hag <br />a. G] <br />t' H <br />Ca <br />HH <br />0uCA <br />H CA <br />HOCA <br />APPLICATIO. FOR CONSTRUCTI N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: &GAS ❑ ELECTRIC ❑ 1 <br />BUILDING DEPARTMENT <br />259-8810 <br />� <br />DEMOLITION <br />COM3INATION <br />)_BUILDING <br />LIMECHANICAL <br />PLUMBING SIGN <br />OWNER rr <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />1'4e, JJA�J'_LA <br />(oa3 &OLSRy�Auc <br />�Y���r <br />leJOI <br />---:, <br />69a <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />'9,4 Axe, p s <br />3-W-AJ-RZ <br />MECHANICAL CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CLASS OF WORK <br />I I NEW I✓ ADDITION ALTERATION REPAIR 1 I DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />//<nJ ��11nn <br />CONTRACT PRICE OF WORK ,()asPa'C HY� py <br />TPERSON AND NE NO WO <br />COWNj� � <br />I'L\✓-Q•-GL2ICu7 as9-3�9 3aIZ -37aL <br />WO$K AND FOOTAGE INVOLVED <br />DESCRIB n <br />iAOTAYh1<,I=onAi9-FKreJA &-rh'R <br />PROPOSED VISE OFBUILDING <br />✓AI IV e <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 />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 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 WAC. <br />LEGALDESCRI TIDN PROPERTY (SHOWN BELOWOR ATTACH FOUR COPIES) <br />OF <br />LOT_ BLOCK GF 7 <br />_ <br />M yy 12&J An Q - E <br />PROTECT ADDRES <br />6a3 M14uL5a 1 k- r ri,el&7r <br />Cc a. <br />SGNATIPIE oAlE <br />P:IS xI GS II 11,11.n - <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AC-A/HNDLG UNITS-H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />_., <br />UNIT HEATERS-B.T.U. M <br />' <br />SHOWER <br />S ' _ <br />CLOTHES DRYERS <br />�— <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />�O' - <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />—i— <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />I — <br />• G <br />SUBTOTAL $ <br />/O - <br />SUBTOTAL $ <br />S ' <br />_ <br />PERMIT $ <br />PERMIT $ <br />i <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: /i a rn aG <br />FRONT SETBACK <br />_1210�` <br />REAR SETBACK <br />SIDE SETBAC� <br />PUN CNECK NUMBER <br />:3 /(r <br />FEE <br />o /Sa. /v <br />RECEIPT NO " ,� <br />egssyl <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />I FEE <br />- <br />ND <br />BUILDING <br />PLUMBING <br />� <br />i <br />TYPE DCONTS.ALLOWABLE <br />•-yA 1 <br />TYPE OF CONST ACTUAL <br />:w 1 <br />�Y-1�/ <br />f.GAPANCI <br />G v <br />xoV Mi. uxirs <br />IZE OOFFBBLD$T <br />NO, OF STORIES <br />BASEMENT <br />No <br />MECHANICAL <br />O � <br />ADDITIONAL PLAN CHECK � <br />70 <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMRATN)N <br />l <br />I <br />iA <br />SPRINKLER <br />—�— <br />REASON FOR SP W'IKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />9L JM <br />TAX CODE IS 3105 <br />TOTAL <br />�� ;,p <br />