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APPLICATIC l FOR CONSTRUCT" 1N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS J ELECTRIC J <br />259-8810 <br />X DEMOLITION 17 COMBINATION 4(l BUILDING rMECHANICAL �(' PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHON[ <br />1o1,T,-I►,�,� ,6wj JZ, k, ellef k-l�,re rY q�ao3 3Li -1�1�`6 <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />_ $A Tin F <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL MNTRAOTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSEt <br />`ThomwsorisQual+� GaTls( <br />'S(ul7 RoG\Le Fe\�yr cy%7x <br />*311%-Ita-Is <br />G\��t�ZQ <br />MECHANICAL C� ONTRACTOR MAILA .HEES <br />CITY ZIP <br />PHONE <br />STATE LICE E• <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />Sny-iL_C& vi. -d \ • rly;l <br />pCITY ZIP PHONE <br />�Av1p% ggoJ.�e -19 5 -1- ll <br />STATE LICENSE a <br />CONTRACT PRICE OF WOR <br />DI[5^RIBE IYOR AND SQUARE FOOTAGE INVOLVED <br />Qec,�,eT,c z - 1'1 as SR Fi <br />CONTACT PERSON AND PHONE NO <br />.latih c h�<. SrJY\ <br />Fc�*,r Go c s cc s- <br />- W of - I ! <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 BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWBELOW OR ATTACH TWO COPIES)-`' <br />BLOCr. S OF Lo HY �S � !❑S— <br />`/�_ <br />Y C) �r�'�. O� Pg��. S'i JaIO �IO�CS`t� <br />�— <br />t�vti S <br />-5+O <br />--t4k <br />PARCEL TAXI D. N R v <br />�-)-oaiS-rJo - ooaZ <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />_ <br />PROJ CT ADDRESS / <br />sa AmHE U4 <br />nusroessucosL NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />;3 <br />WATER CLOSET (TOILET) <br />A/C—A,HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER E <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />WOOD S1"OVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUN IAIN <br />FIREPLACE INSERT <br />; <br />_ <br />FLOOR DRAIN <br />HEAT PUMP _ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC) <br />SUBTOTAL S <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: h� 5 <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK ! <br />PLAN CHECK NU61 <br />FEE �r ,rD <br />`�"(r/`VrJALUAO✓TION <br />RECPT N <br />lO����_ <br />`/-'J/`�FFEEEESOJ <br />usEzoNE <br />LOT AREA <br />VACANT SITES <br />FEE <br />BUILDING <br />16 p3 <br />(pC% Cj' 00 <br />17 YES ❑ NO <br />TYPE O—frLOfNS1 <br />HO. OF STORIES <br />OttuWIUN[r NG OF NVLwNGUNITS <br />C <br />�—/J <br />Z— <br />•3 <br />PLUMBING <br />SIZE OF <br />FIRE SPRINKLERS PEGG <br />BASEMENT S <br />MECHANICAL <br />(� I dD <br />In52 C*AK <br />p <br />C YES VNO <br />ADDITIONAL PLAN CHECK <br />I I �v <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />Q <br />0 <br />OTHER <br />/0 i co <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVE BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />I <br />�J� <br />LOCAL SALES <br />DATE -7i <br />TAX CODE IS 3105 <br />TOTAL <br />n, �� <br />