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Amy <br />9 H3 <br />p:Dx <br />ay~ <br />rx <br />Haa <br />H3 z H <br />Fc H3 � <br />TJ " IV <br />(n H <br />r om <br />H C7 <br />ZOE <br />�n <br />H <br />HH <br />�y <br />H <br />r) 0 ti <br />14 <br />LA <br />1z3 OCAA <br />APPLICATIC I FOR CONSTRUCT; IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM.: 'U GAS Ll ELELECTRIC ❑ _ _] <br />BUILDING DEPARTMENT <br />259-8810 <br />i DEMOLITION Cl COMBINATION ❑ BUILDING MECHANICAL I PLUMBING SIGN <br />ER n MAR ADDRESS CITY ZIP PHONE <br />77A) ®C o v,1/iz � v2/// lei oeno ' .s<c '57 . elvz' - 2S6 - /0 7 f <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNF R MAIL ADDRESS CITY ZIP PHONE <br />/ /o"7ml_sDa,L L' <br />%�al✓>S <br />-/S��S� •�tu�/.�7 /�`iLd1� //%r9�yJONE <br />� /rtrzro <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY zip <br />PHONE <br />LICENSE <br />STATE IK;ENSEt <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT CE OF K <br />4Oo <br />DESCR E RK $dIARE FOOTAGE INVOLVED r / <br />CONTACT PER N A f /PHONE NO ! z <br />/ <br />U / d <br />70 67,J F7" 4(y r A Ai( <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPISSED USE OF BUILDING <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 ISHOWN BELOW OR ATTACH TWO COPIES) <br />� ` <br />71f Cc)V/ (� � y-O L cT"' LC 4 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />OF ANY <br />LOTS BLOCKV OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS <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 />W 18.27 RCW AND 296.200 WAC. <br />PARCE TAK I D. NUMBER <br />o/S Yr//-vo7 -000U <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />RCH;ANIC6AL <br />PROJECT ADD SS <br />DATE <br />/ <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-AjHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />- <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />nt-tC c'-f; A ncn.I. H. / ,CIA (1(z, <br />rvn vrrla.� v.ax. <br />vnx... �rnv Ac. <br />rv.�— <br />FRONT SETOBACK <br />REhR SET <br />SIDESETDACK <br />PLANCHECN IMBER� FEE �� <br />RECEIPT NO. <br />Z <br />zo <br />S <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />BUILDING <br />4.S 5 <br />72 ' <br />I <br />0 X /zo <br />I1 YES L3'NO <br />TYPE Of LONST. <br />NO. OF STORIES <br />acuvANLr <br />NO avAmixc uxrts <br />V- <br />I <br />GN"'P <br />Q3 <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RED <br />BASEMENT <br />MECHANICAL <br />wo <br />❑ YES Fi NO <br />ADDITIONAL PLAN CHECK <br />APoij <br />OCCUPANCY LOAD <br />FIRE ALARM REGD <br />HEIGHT LIMITATION <br />WIA <br />IP <br />OTHER <br />� <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED OV <br />CITY OF EVERETT <br />PUBLIC WORKS <br />J `p1 <br />LOCAL SALES <br />TOTAL <br />TAX CODE IS 3105 <br />DATE 3 43 �{ <br />ff <br />