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APPLICATIL A FOR CONSTRUCT .ON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT �Jtfrr <br />I HEAPING SYSTEM: J GAS J ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMRINATION \ BUILDING MECHANICAL <br />PLUMBING SIGN <br />_ <br />OWNER <br />MAIDDRESS <br />L A <br />P✓OX <br />CITY <br />;;.� ac-7� <br />ZIP <br />.;CSFTLIC !•✓A. <br />PHONE <br />�er(z�t <br />7V2- '1:7<0 <br />.',707 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />71P <br />PHONE <br />�M C A-s <br />O M ^16-A, <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />r(Hr A-Usrel <br />c� <br />ZIP <br />PHONE <br />STQELICENSE . <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />� <br />54-1-LC PS <br />NLrM1� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE. <br />nPIAnI ITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />NEW AUUII IU:...... ___ <br />-- <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORM I2 �• <br />DESCRIBE WORN AND SQUARE FOO AGE IN LVED <br />,N6VM lUfz uSE�77�S�OC SF <br />�TIL <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />I <br />TO BE TRUE AND CORRECT. ALL <br />(-7AIE Al MA rI L, T- L'ITE C e',v K• C L <br />APPLICATION AND KNOW THE SAME <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 ISNOWN BELOW OR ATTACH FOJR COPIES) <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />--- <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 />.. :AdI UPI OAIF <br />PROJECT ADDRESS ./ <br />3Qp3 tv. CY•%i/d0 ZZQ A/��Z� <br />c•.euswrssl¢ursF No <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET, <br />AC—A-HNDLG UNITS— P. <br />_ <br />FORCED AIR SYSTEMS--B T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-8 T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />WASHER <br />WOOD STOVE <br />_ <br />CLOTHES <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <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 $ <br />SUBTOTAL S <br />PERMIT S <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE S <br />' <br />FOR OFf IL;L U,F. <br />FRONT SETBACK <br />USE ZONE <br />UIVLT: <br />REAR SETBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />PLAN CHECK NUMOE FEE <br />FEES <br />VALUATION <br />RECEIPT NO <br />FEE <br />BUILDING <br />d FZF/'-' <br />� , <br />TYPE OF COBTS AILON'ABLL <br />TYPE 01 CONSI ACTUAL <br />0¢ul." <br />LO n DrAmxc ul`s <br />PLUMBING <br />MECHANICAL <br />SIZE F BLDG <br />12 50 A."' <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PL IN CHECK <br />417A 6-5 <br />OCCUPANCY LOAD FIRr SPRNKLERS REC'D HEIGHT LINCTAllON <br />3 y�S <br />REASON FOR SPRiNNlERS <br />SPRINKLER <br />STATETATEBBUILDING SURCHARGE <br />f <br />q r <br />v — <br />PUBLIC WORKS <br />INTAKE BY <br />PLAN <br />PPROVED BY <br />yT <br />A 1'{� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />LDTAL <br />