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I <br />APPLICATIC I FOR CONSTRUCT IN P';RMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: (GAS ❑ ELECTRIC ❑ _ <br />259-8810 <br />X DEMOLITION I COMBINATION <br />OWNER MAIL ADDRESS <br />c1glLnThoTon��3b(�l� R,�� e, a ej <br />TENANT MAIL ADDRESS <br />S %g <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />p���un L�nec <br />GENERAL NTRACTOR MAIL ADDRESS <br />Th o m wsorisgkm\ +l j consy 5c„ 1- <br />MECHANICALCONTRACTOH MAIL Agr RESS <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />BUILDING <br />J,i'MECHANICAL Xi PLUMBING Cl SIGN <br />CITY <br />ZIP <br />5$ao3 34j- <br />CITY <br />ZIP PHONE <br />CITY <br />21P PHONE <br />4QuAIL-c-v <br />�� � 353-0531 <br />CITY <br />Rom\teFe\\uro <br />ZIP PHONE STATE LICENSE L G\ <br />CITY ZIP PHONE STATE LICE E a <br />CITY <br />ZIP PHONE <br />-In r,I ll <br />STATE LICENSE <br />CONTRACT PRICE OF 1VOR <br />DESCRIBE WO? AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PI/ONE NO <br />C-0,t Gwc'0.c j 1j�r�ne�A�s CaC s— <br />3 �]] p_ W 6 <br />T off C +A_ <br />�S <br />(IeciC ��.� �4. Tom— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING ��--- <br />_ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHE R SPECIFIED HEREIN OR <br />LEGAL DE SC IT PRON OF TROPE RTY(SHOWN BELOW OR ATTACH Two co`P,lE s) <br />�L. <br />S I su`r QA t+E+W*s <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />THE PROVISIONS OF ANY <br />LOT— BLOCK. OF <br />AUTHORITY TO VIOLATE- OR CANCEL <br />I Q Qq --% S4 �----- <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 />1h`n Si'oN-k.� p�T V.i� <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />PARCEL TA% D. N R <br />ti°ISR-oa`6-aoS- ooa2 <br />-- <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER, <br />PROJ CT ADDRESS <br />sIc ❑unL D"TL <br />nvnusNLssllccu5L.0 <br />/ <br />PL MBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE _ <br />3 <br />WATER CLOSET (TOILET) <br />ABC—AIHNDLG UNITS—H.P. <br />I <br />' <br />' <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 (U ^ Q'%,L 1 <br />' <br />CLOTHES DRYERS <br />' <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />__—r— <br />METAL FIREPLACE (WOOL) BURNING) <br />; <br />URINAL <br />; <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF OR.41NS—RAIN_LEADERS <br />EXHAUST FAN / / / <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT S <br />PERMIT _. <br />TOTAL FEE S <br />TOTAL FEE $ <br />' <br />FUH UFf-JUL we <br />FRONT SETBACK <br />UnLT: <br />REAR SETBACK <br />> <br />SIDE SETBACK , <br />FEE <br />PL 4N CHECK NU617, <br />C'.F /EEESD% <br />4q g nO <br />RECEIPT NO _ <br />�O c��s <br />JFEE <br />USE ZONE <br />LOT AREA <br />VACANT SITES <br />VALUATION <br />BUILDING <br />' QU <br />❑YES ❑ NO <br />TYPE OF CBNST <br />NO. OF STORIES <br />=Pmcr <br />AMP <br />NO 01 (OATH ING UNITS <br />PLUMBING <br />� <br />91 � Q <br />—1� <br />Z- <br />MECHANICAL <br />(] TJIi <br />SIZE OF FLOG � <br />S` <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />NO <br />ADDITIONAL PLAN CHECK <br />_ <br />w <br />f?2Z <br />G YES G <br />OCCUPANCY LOAD <br />FIRE ALARM PEG <br />HEIGHT LIMITATION <br />L,( A <br />0 <br />'OF, <br />OTHER <br />— <br />REASON <br />STATE BUILDING SURCHARGE <br />1`ITAKE BY <br />PLANS APPROVEP BY <br />CITY OF EUERETT <br />PUBLIC WORKS <br />J 1r�+ <br />LOCAL SALES <br />n <br />TAX CODE IS 3105 <br />TOTAL <br />qOS <br />DATE 7 <br />