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APPLICATIO." FOR CONSTRUCTI^N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J -- <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL F' PLUMBING k' SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />r W,I)jAa 3:)3 a..d St s"o4Q".sk 98z90 5bE-o5-1y <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />Lowcll A.,iv RVA,K� 42Ao s 3odA,c E-ica'lf gSA03 ass-iscly <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAII. ADDRESS CITY ZIP PHONE STATE LICENSER <br />_Fen Ai* <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSER <br />I <br />A <br />U <br />CONTRACT PRICE OF WORK <br />Soa o. <br />DESCRIBE WORK AND SOUAHE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. A 4 m <br />� m -i1NtcK elSC3-38-T1 <br />— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BF 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 O- 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 />a-aa •9y <br />PROPOSED USE OF BUILDING <br />A,A+o 1 <br />LEGAL DESCRIPTIONOFPROPERTY ISHOAVN BELOW OR ATTACH TWO COPIES) <br />LOT 30 BLOCK OF <br />PARCEL TAX 10 NUMBER <br />GI - I(.:z <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS /� <br />yaps S, 'i08 Avk <br />SIGH TU11F RITE <br />Ca HUSINESSLICENSENo <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—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />LAVATORY (WASH BA£N) <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOC') <br />�— <br />!-AUNDRY TRAY <br />WATER HEAL ER <br />CLOTHES WASHER <br />WOOD STOVE <br />i <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />1 <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />�33TiT3�CR 3�PI\Y <br />I ANT SETBACK <br />PEAR SETQACK <br />7 /I /ETE <br />SID SBACK <br />PLAN CHEC NUMBED <br />7(�7-7 <br />FEE <br />RECEIPT NO <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑YES ❑ NO <br />IFEES <br />VALUATION <br />FEE <br />_ <br />BUILDING <br />PLUMBING <br />W <br />1 <br />1 <br />TYPE Of CONST <br />NO. OF STORIES <br />GGCUPANGY <br />GNwP <br />NG INMUING UNITS <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />1 <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM F'EO'D <br />HEIGHT (IMITATION <br />OTHER <br />REASON <br />STATE_ BUILDING SUHCHARGE <br />INTAKE BY <br />PLA ROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />19 i� <br />