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APPLICATIO' n' FOR CONSTRUCTrN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS J ELECTRIC ) <br />259.8810 <br />Ll DEMOLITION Ci COMBINATION %BUILDING I .; MECHANICAL IJ PLUMBING SIGN <br />OWNER MAIL ADDRESS //CITY ZIP PHONE <br />(3os/N6 llo•i ' i �oY37a7 ryso!h-i3, S� 7m!r �wA•?tl2-y 3Vz--7379 <br />TENANT AIL ADDRESS CITY 7 ZIP PHONE <br />jO4-- I AJ 6 - <br />ARCHITECT OR MAIL ADDRESS CRY ZIP PHONE <br />Phr AtiST/� Co• <br />GENERAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE STATE LICENSE <br />SaL CARP . <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY • ZIP PHONE STATE LICENSE <br />CONTRACT PRICE Of WORK <br />\0q o00 <br />DESCRIBE WORK AND SQUARE F�D�irGE INVO VED <br />Go WS9'It-uc1� GK6''L it+L Ctima <br />CONTACT PERSON AND PHONE NO. <br />(.lco,vsn/> STEAnBORSkI 2,66.3SG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC . 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 118.27 RCW AND 2966►2�0000 W�AACC •/n <br />Y''� �� �'✓�T ,I L'/!���' <br />PROPOSED USE OF BUILDING <br />%%//LC2A}Fr Mf'fi • <br />LEGAL DESCRIPTION OF PROPERTY,SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT BLOCK — OF <br />-- <br />PARCEi TAX 10 ❑uL'-0EK <br />LONSi RUCLG: ICP❑LENGEH ADGPE55 TELEPHONE NUMBED <br />PROJECT ADOIFIESSS n (y/ <br />3OQ3 W. LiEpTAAt10 �%�� / D���� <br />B/59 <br />ATLPE DATE <br />Ci1Y BUSINESS LICEN'IFNO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSFT (TOILET) <br />A/C—AMNDLG UNITS—H.P. <br />_ <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 <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />r— <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLE AIDE aS <br />EXHAUST FAN <br />S'n-; (SERVICE —BAR ETC I <br />i <br />T <br />SUB TOTAL 5 <br />SUB TOTAL $ <br />-- <br />_ - - -- — PERMIT -$ <br />�— <br />— <br />- PERMIT S--- <br />T <br />TOTAL FEE S. <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECK UMBER <br />FEE <br />RECEIPT NO <br />6 �­A <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑ YES E, NO <br />BUILDING <br />IY) OF CBNST/ <br />NO Of STORIES <br />D2V Y <br />NO aBATuuw IAlLs <br />PLUMBING <br />SIZE OF BLDG. <br />T• d <br />FIRE SPRINKLERS REDO <br />ASEMENT <br />MECHANICAL <br />S <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />— <br />CUPANCY LOAD <br />FBAPALARM REOO <br />NEIGNT LIMITATION <br />ye <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANSAP ROVED BY <br />�k <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />, <br />DATE S _ : <br />TAX CODE IS 3105 <br />TOTAL <br />