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APPLICATIC-­" FOR CONSTRUM-A PEPMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ __ <br />259-8810 — <br />_DEMOLITION i COMBINATION BUILDING 17 MECHANICAL_ al 11Fu1NINF: QI/]AI <br />MAIL ADDRESS <br />9CCIAIe Ca.. Re.3-)a7 <br />ar PHONE <br />l-/z ,StfRTLCf u/9. (%00/2y 2LC <br />CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE — <br />rtNc /,}ufrAAA Gd , <br />GENERAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE STATE LICENSE) <br />r#6 4-v5rir co. <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PINKIE STATE LICEMIIEI <br />PLUMBING CONTRACTOR MAR ADDRESS CITY ZIP PHONE STATE IX:EN3E1 <br />CONTRACT PRICE OF WORK <br />�0 a oa <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />�O NAFcI.i �TE7+7/�OitS/c / 24(, -?.sC7 <br />CaDUSEO ucr 6AN ,iGY$ <br />I HEREBY CEPTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />A1ac/LA. FT lkrc <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />.. <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 TWO COPIES) <br />LGT BLOCK CIF <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 />_ --- <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TAXI NUMBLY. ---- <br />CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br />X <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />3m7 C�. GRs/.,6 ,2d, <br />yd_ j <br />W,L <br />Coll BM[BF tiC.I:NS[ NO <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 />AIC-A/HNDLG UNITS-H.P. <br />, <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />T <br />UNIT HEATER&-B.T.U. M <br />' <br />_ <br />SHOV/ER <br />' <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />' <br />DISHWASHER _ <br />1 <br />RANGF HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />1 <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />- <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />I <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I ' <br />- <br />1 <br />I <br />I <br />1 <br />_ <br />SUB TOTAL <br />$ <br />; <br />SUB TOTAL $ <br />— <br />PERMIT <br />$ <br />PERMIT $ <br />1_ <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />run UL•FLCE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />BIDE SE79ACN <br />PLAN CHECK NU BE <br />FEE <br />RECEIPT NO <br />L V. <br />USEZONE <br />70TAREA <br />IACANF SITE <br />FEES <br />VALUATION <br />FEE <br />_ <br />❑ YES ❑ NO <br />BUILDING <br />TYFE OF CONST <br />NO. OF STORIES <br />BCLuAWf.T <br />WIXIN0RLMLM1r; <br />PLUMBING <br />"- ) <br />— <br />GRwP <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />JOJ ;Q T. 1, <br />Y(f <br />❑ YES L7 NO <br />MECHANICAL <br />�— <br />OCCUPANCYLOAD <br />FIRREGD <br />HEN3NT LWID11N7N <br />ADDITIONAL PUN CHECK <br />CJ� <br />Y£J <br />OTHER <br />_-- <br />REASON <br />Fit E' I <br />R <br />STATE BUILDING SURCHARGE <br />5� <br />INTAKE BY <br />BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />' <br />TOTAL <br />DATE .� . S <br />TAX CODE IS 3105 <br />