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APPLICATIC I FOR CONSTRUCT' IN <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION I <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC 0 _ — I <br />MICHIIECTOROESKNER NAF AZCI CRY ZIP PHONF <br />OENER.LLLCPORACTOR MAAAODREss 2S7 cm rP P (&OG STATELK.ENSEP <br />SoixeryOMESSM[. 6cM STREET SUEI¢ETrAWA.-gSZ05 958•11503 5I5LELHS110KA/ <br />MECN/NILALCONfRACipa YAE ADDRESS CITY ZR P11CNE STATE MENSE0 <br />PLUMBNO IMIlaAC1CR MLADDRC55 Cm ZP PNONf STATE CK. I <br />CONTRACT PRICE OF PIORX <br />y0000 <br />pE5G11BE Npllt AND SOUAIiE FWIADE INVIXViO <br />Cb11ALt RRSdI ANDRY.INF NJ <br />9AAJcIY cl-ARK 258- /50 <br />Co.UStR[(ft/U.V OF S/NGLE FAmIl <br />AA" tLfCff 339-0555 <br />2rSfpow LE <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 18.21 RCW AND 296,200 WAG, <br />sf�E�f HOM�s =A<. <br />X <br />PaoPosso use of euFDMD <br />S/NGLE I'r1MfLY RES/OL�NLE <br />ttEAL«SCAMT OF PROPERTY Is.pxxWtMOR A1TE.C14TAO COPIESI <br />mr az«K a <br />P1 Tf 3 <br />PARCEL TAXI u IAwER <br />SNna, .2 <br />LEPISLPULTICN LOAN LEN«R. ACOIEN.TELFPI(":.lv 4 11 <br />PROJECT ADDRESS <br />W.T 3RDDR• W. CvC9CiT ✓A. 76ZOS <br />rnYMnPA,AIII.K <br />- -. <br />PLUMBING <br />MECHANICAL <br />N0, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPEOPEOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AjC--AHNDLG UNITS—H.P. <br />2 <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. UE.A. <br />2 <br />LAVATORY AWASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />/ <br />CLOTHES DRYERS <br />/ <br />KITCHEN S'NK S DISP <br />VENTILATION FAN <br />DISHWASHER <br />/ <br />RANGE HOOD <br />LAUNDRY TRAY <br />/ <br />WATER HEATER <br />/ <br />CLOTHES WASHER <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 />i <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT f <br />TOTAL FEE S <br />TOTAL FEE $ <br />EPOHL SETBACK <br />Iz <br />EAR ALTBACA <br />slre <br />SIX SETBAIX <br />PIAM CNFCKN <br />�{oIF <br />EE <br />30 <br />RFC i <br />10 33 <br />USE mNE <br />{= ` <br />L TAREA <br />i Yi8-7 <br />VACANT SITE <br />(7 YES ;l NO <br />FEES <br />VALUATION <br />FAE�E <br />BUILDING <br />PLDMBINEI <br />g O <br />(j <br />t„J J 5-6irHpC0X51 <br />NOOFSTORKS <br />Z <br />ucnrn 1paamia4 Wii <br />3 <br />6MEZaz F t <br />I <br />460 S0 <br />FIRE SPRINKLERS AEOD <br />BASEMENT <br />❑ YES NO <br />MECHANICAL <br />— — <br />ADDITIONAL PLAN CHECK <br />oCCUPANtr LOAD <br />FIRE AIARM uan <br />O <br />A <br />HFIdITI RATgN <br />Q/y <br />HEASON <br />STATE BUILDMG SURCHARGE <br />4/ <br />INTAKE BY <br />DATE <br />PIANSA DIFY <br />�/f� <br />G�5�93 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLICWORKS <br />TOTAL <br />— <br />