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APPLICATIV.1 FOR CONSTRUCV" J' N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT ffrT <br />BUILDING DEPARTMENT <br />259-8810 <br />a DEMOLITION COMBINATION <br />OWNER../CrL11AIL ADDRESS <br />V\I()rm l NoIICTml =7, 5oS LAU21 <br />G <br />B <br />HEATING SYSTEM: <br />BUILDING <br />ELECTRIC ❑ <br />MECHANICAL PLUMBING <br />ZIP PHONE <br />A afV7ni Zacl--I'II47 <br />I SIGN 1 <br />-FA - <br />ARCHIFECTORDESIGNER MAIL ADDRESS CITY ZIP PHONE <br />cNIA1J PAZCk4 rc�� I6L� I-l�l t-Tr AUZ_ E1)Equ1 s 7 Lug • 9fS'm1 i-3l 1 <br />GENERAL CONTRACTOR MAIL ADDRESS CI_TYL ZIP P.ONE LICENSE <br />Litt ZIP PHONE STATE LICENSE0 <br />MECHANICAL CONTRACTOR MAIL ADDRES ..q�.- ��- <br />Y -L�-i / n_�A <br />11 n 1, cGQ-�^. '-6ky- <br />PLUMBING CONTRACTOR MAILADOR S5 CITY ZIP PHONE STATE LICENSER <br />>e NOUG= 1ZEzQ . <br />CLASS OF WO K <br />I I NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />pfgc//, <br />•isF <br />CONTACT PERSON AND PHONE NO. <br />%ZeWoA-1 <br />2.� 000 / <br />'�M --- <br />CONTRACT PRICE OF WORK o <br />C <br />-' <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />l$GO 5. "o bQ <br />. <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />L1,1YL�t�->,rj.OU S>= <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 BELOW OR ATTACH FOUR COPIES) <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESI)ME TO GIVE <br />LOT <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />cn- n <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />;�X /O 44 /Fp /`'G.S' - a _Q' 4 - of <br />OWNER OF THIS PROPER OkEflFORM THE WORK FOR WHICH <br />APPLICATION IS DE .D I MPLY WITH THE STATE <br />CONTRACTORS 18. A 29 .200 WAC. <br />N... 9 <br />l0 9 q-Z <br />PROJECT ADDRESS^^ <br />SK✓+ATOPE DAtE <br />T�' `1 �1' ���}A _ <br />� i\, w 1�l/.>•1`Ijvl1 115W D` UG <br />dtv RMWM IKf NSE NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />N0. TYPE OF EQUIPMENT FEE i <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <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 />_ <br />DISHWASHER <br />RANGE HOOD <br />' <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLAC CHIMNEY <br />DRINKING FOUNTA <br />FIREPLACE IN T <br />i <br />FLOOR DRAIN <br />HEgTIFMBACKFLOW <br />EVENTERS <br />GAG <br />ROOFD NS-RAINLEADERS <br />EXT FAN <br />SINK RVICE-BAR, ETC.) <br />T_ <br />, <br />, <br />�— <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />run urri .c uao <br />FRONTSETBACK <br />annu. <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECKNUMBER <br />3SI36` <br />FEE <br />Tc 0 <br />RECEIPTNO. <br />i3�6 <br />USEZONE <br />li ��A <br />LOT AREA <br />VACANT SITE <br />b <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />•7f zx <br />3/7 '00 <br />TYPE OF CONIS. ALLOWABLE <br />7Z-N <br />TYPE OF CONS? ACTUAL <br />77-A ' <br />Jl/V <br />ar v <br />ASP <br />,ro dmnuixcwn5 <br />� <br />PLUMBING <br />I <br />i <br />MECHANICAL <br />- <br />— <br />) <br />S E L NO OF BTORIES BASEMENT <br />,a ii ° t nA r PO <br />OCCUPANCY LOAD FIRE SPRNKLERS REQQ HEIGHT LIMITATION <br />UK A'F <br />REASON FOR SPRINKLERS <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />I <br />PUBLIC WORKS <br />` <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />O j Sn <br />ry <br />Er <br />