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APPLICATI" FOR CONSTRUCT" IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS b ELECTRIC J _ J <br />259-8810 <br />K DEMOLITION COMBINATION A BUILDING )<MECHANICAL K-PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Pg�i Glasser 1196% V;Ac, PL. E%JcvT-vt I,,,C z 3 �z�6�-z5z <br />TENANT MAIL ADDRESS CITY Z PHONE ' <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />ucnrn wrvinna, wn <br />MECHANICAL CONTRACTOR <br />PLUMBING CONTRACTOR <br />MAIL AUUHtSS <br />MAIL AVUHt SS <br />MAIL ADDRESS <br />PHONE STATE LICENSE X <br />un nnUNt SIAI t LIULNSEX <br />ZIP PHONE STATE LICENSE s <br />CONTRACT PRICE OF WORK g66o.aV ,l <br />DESCRIBE \PORK AND SOUR <br />c <br />E FOOTAGE INVOLVED <br />e Liv;u Arw - <br />CONTACT PERSON AND PHONE NO <br />dro M I l Q•.+ <br />V1/� �� ZS2- 933 <br />otw 4 llrY $ <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 PHOVISIONS 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 />- <br />PROPOSED USE OF BUILDING 1 <br />fS i�{V� t �\ <br />LEGAL DE�SCCRIPTIO14 OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />LOTBLOCK OF - V E�-Ea R <br />a�1G0� K S-Q�VL(A4 <br />PARCEL TAXI . NUMBER Q <br />_ee(pS - 0510 _O J - 40� <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />C�9r.�� <br />scNAmPL �-- PATE <br />CITY NOSiHLSS UCI 1]l IL, <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 />AFC -A HNDLG UNITS-H.P. <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />i <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />I <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <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 />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />( <br />1M1"L 1- ^ ° k Aie ac . <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $j <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <M71CF. 11ZI o 08c: <br />FRONT SETBACK <br />REAR SETBACK <br />l <br />SIDE SETBACK <br />�� <br />PLANCgEC NUMBER <br />�{ /3Co <br />FEE — <br />1 Wo. v <br />RECEIPTNO. <br />ps/S <br />US� <br />LOT AREA <br />VACANT SITE <br />YES D NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />cl6 p <br />oU_ I <br />TYPE OF CONS( <br />NO. OF STORIES <br />GCCUPANGv <br />'p°3 <br />NOINMIAINGGNRG <br />SIZE OF BLDG <br />�JZ 17F. <br />FIRE SPRINKLERS REO'D <br />O <br />BASEMENT // <br />E YES �!NO <br />MECHANICAL <br />I �� <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HEIGHTLIMITATIOjI <br />� / <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />�SU <br />INTAKE BY <br />PLANS APPROVDBY <br />_ ij <br />DALE Z y q <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />L <br />