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APPLICATIGA FOR CONSTRUCT_JN PERMIT <br />V TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT EATING SYSTEM: U GAS U ELECTRIC U _ <br />259.8810 <br />DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAlI AppRESS <br />CI1Y <br />ZIP <br />PNONE <br />Tlf✓r ��EINC, �'•) n0.i$Ux <br />?7o7iM/5r'F--'7LI <br />SE/F7rLLr.-�v✓4 <br />'jBiZ-Y L-73'19 <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />5 4'x'7 f h5 o L✓" T_ .L <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />C TY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />LcJf s; UE� � <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSER <br />NEW ADDITION Y ALTERATION REPAIR DEMOLITION WOODSTOV&FRPL INSERT BUILDING RELOCATION <br />�f r� <br />CONTRACT PRICE OF WORK 'E I / 0 CIO <br />CONTACT PERSON AND PHONE/W <br />�:J Yl/A-/L /i /1> %Gry�i O ICS Ad <br />DESCRIBE WGRK AND SOIIARE FOOTAGE INVOLVE <br />GIG Vc/✓r(L_/hriv F% <br />PROPOSED USE OF BUILDING <br />1 ax_-0 4-F'r S S c," OL V <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 18.277RRCCWW AND 296.200 WAC. / <br />X . <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK <br />PRGIECT ADDRESS <br />350-3 W- C4s(A10 20. 4 a —23 <br />Sq TURE DATE <br />CITY 8USME69l,LENSE xq <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-A HNDLG UNITS-H.P. <br />, <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK d DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />, <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />; <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />, <br />EXHAUST FAN <br />, <br />SINK (SERVICE —BAR, ETC.) <br />' <br />, <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />377 9/ <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />f sty <br />Qo2 iDo' <br />TYPE OF CENTS ALLOWABLE <br />I ) - N% <br />TYPE Of CONST ACTUAL <br />_ A) <br />accuvAxcr <br />cxav <br />� 2 <br />iq OT iMTIIiNG urns <br />PLUMBING <br />' <br />SIZE CF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />i <br />ANAL PLAN CHECK <br />30 <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />I-'- 37A J6[ <br />REASON FOR SPRINKLERS <br />(J P f;5 . <br />SPRINKLER <br />� <br />, ' <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PINS <br />APPROVED BY <br />I/I�1Y_IN` <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />