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APPLICATIC 1 FOR CONSTRUCT 3N PERMIT OL <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT /) e Al <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS >ELECTRIC f] _ <br />259-8810 <br />DEMOLITION `f COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />TENANT MAIL ADDRE S CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />�r L <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSED <br />CLASS OF WORK,>'y , -- <br />NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVFJFRPI INSFRT RI III nimr. Rcl nr ATInKI <br />CONTRACT PRICE OF WORK �� /U Q L/� <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK ANDS UARE FOOTAGE INVOLVED <br />PROPOSED USEOF BUILOI <br />S ` <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 RY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK F.,T WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE �v DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACHFOUR COPIES) <br />' /, <br />J BLOCK D�of I/, (..( <br />�n <br />- 9 <br />PROJECT ADDRESS 1;791(l/,/�/p' y1 / ))�/ �(' <br />/' `� ��� / </ yv <br />1 <br />l <br />CTY BUSNESQ LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />NC-A/HNOLG UNITS-H.P. <br />; <br />_ <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />- <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />; <br />_ <br />SHOWER <br />/ <br />DRYERS <br />I <br />KITCHEN SINK & DISP _ <br />_CLOTHES <br />VENTILATION FAKI <br />I ' <br />DISHWASHER <br />' <br />RANGE HOOD_ <br />I <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />i <br />CLOTHES WASHER <br />/ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMPS-- <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RA114LEADERS <br />T <br />EXHAUST FAN <br />_ <br />SINK (SERVICE -BAR, ETC.) <br />; <br />T- <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: ' R / <br />FRON SETBACK <br />20i NAiw <br />REAR ETB <br />How LSoa Rr»u lh <br />SIDESETBACK <br />T Yh, N <br />PLAN CHEC�p UMBER <br />�<7 ' Sc) <br />FEE <br />RECEIPT O. <br />USEZONE <br />L(OOTAREA <br />"' <br />VACANT SITE <br />0 <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I q -7.1U <br />I ' <br />TYPE OF CONES. ALLOWABLE <br />TYPE OF CONST AJJUAL <br />=UPAHGROU,p <br />?-3 <br />NO of MILLING UNITS <br />I <br />SIZE OF BLDG. <br />439 sf AOQY <br />NO. OF STORIES <br />2 <br />BASEMENT <br />MECHANICAL <br />_ <br />ADDITIONAL PLAN CHECK <br />nSAS; <br />OCCUPANCY LOAD <br />N <br />FIRE SPRNK��))LERS REOD <br />r, <br />HEIGHT LLIIIMITATION <br />��/ 1 <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />! �� <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />N 1 IL�I/�L <br />TAX CODE IS 3105 <br />TOTAL <br />), <br />35�. 9 c <br />