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H C]H <br />C+1 � <br />o C <br />ay <br />� H <br />�Hxa[n <br />HC L7 <br />H 0 <br />Ox14 <br />HitH CAH <br />O� <br />H3 C7 <br />OH <br />wog <br />9H <br />t" H H <br />gCA <br />ei ri � <br />tm, <br />H yO In <br />VAVAAMJ <br />APPLICATION FOR CONSTRUCTK.N PERMIT TALL <br />the EYergwn TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />eve rett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC 0 <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL ❑ PLUMBING SIGN <br />OWNER 4)/Aw �9y/9�N MALL <br />3GU7ADDRESS <br />l?vckeANer J-vereTr `Ids � ZIP PHONE <br />0s12-­29.S_3 <br />TENANT MAR ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />II <br />MECHANICAL CONTRACTOR MAR ADDRESS Din ZIP PHONE LICENSER <br />PLUMBING CONTRACTOR MALL ADDRESS CITY ZIP PHONE LICENSER <br />CUSS OF WORK <br />'.1 NEW (ADDITION ❑ ALTERATION ..' REPAIR ❑ DEMOLITION WOODSTOVEIFRPL INSERT C. BUILDING RELOCATION <br />CONTRACT PRICE OF WORK � <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE �WORK AND SOULAPIE FOOTAGE INVOLVED <br />E IJ �'ID a 1 C. A R C7 A^A-A<YF <br />PROPOSED USE OF BUILDING <br />6ciragj, 7-i7 A , Z R_ <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 GOVERNINC 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 1 AM AUTHORIZED BY THE <br />OF THS FOR WHICH <br />A PL CATION( IS RMADET ANDPRFORM IE COMPLY WITTHEOH KTHE STATE <br />RS LAW 18,27 RCW <br />SIGNATURE DOFGCONTRA CONTRACTOR AUTHORIZED ALGOL OAT . <br />_ LEI <br />APPLICANTS CITY BUSINESS L ENSE NO. DBUSME55 NAME <br />LEGAL DESCRIPTION PROPER (SHOWN BELOW OR ATTACH FOUR COPIES? <br />LOT BLOCK OF <br />TH66ot)-tA 2./3 6 f LoT qgnd 'tile ffirTn <br />_ <br />113 OTLOTOWNER <br />in & k 992 o{7ire Pl�rof <br />\, " <br />�t%A/� / �T ,I /n <br />L[`/K/� //Z��C � 6= <br />PROIECTADDRESS <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 />A/C—AIHNOLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />I <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />I <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHLO WASHEfl <br />I <br />WCOD STOVE <br />i <br />URINAL <br />I <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMP <br />I <br />BACKFLOW P13EVENTERS <br />) <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />__ <br />SINK (SERVICE —BAR. ETC.) <br />I <br />i <br />I <br />I <br />I <br />i <br />- <br />T <br />SUB TOTAL $ <br />SUB TOTAL $ <br />; <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: 3 r So <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />2535- <br />RECEIPT NO <br />57907 <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />PLUMBING <br />}'��Imo— <br />yp 00 <br />TYPE Of CON75. ALLOWABLE <br />TYPE Of CONST ACTUAL <br />AL <br />aCUPAKr <br />GROp° <br />w " BNTNMG ALL <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />i <br />1 <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS RED HEIGHT LIMIiAi N <br />N IUD � � h � <br />OTHER <br />i <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />T <br />I ,� <br />INTAKE BY <br />PLANSAPPROVED BV <br />CITY OF EVERETT <br />J� �9L <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />/� 7 �� <br />