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APPLICATIC <br />I FOR CONSTRUCT <br />)N PERMIT <br />1v <br />5 <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: _ GAS ❑ ELECTRIC <br />J <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION <br />CI COMBINATION I 1 BUILDING ! MECHANICAL PLUMBING SIGN <br />OWNER <br />MAILADDRESS <br />CITY ZIP <br />PHONE <br />,CVAA.% ANyeX: <br />Jmd0'7 <br />G//STII �, - D�-• c)s Znj <br />Z551 G7o / - <br />TENANT <br />MAIL ADDRESS <br />CRY ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE• <br />MECHANICAL CONTRACT q <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE. <br />/ - ,Alb <br />/10l Cl�ST�, <br />Q, CVT Z.19!' �33Y`% <br />*4,_96" e gaoc- <br />PLUMBING CONTRCC OR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE. <br />CONTRACT PRICE OF WORK <br />74g?U <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PEPSON AND PHONE NO. <br />I HEREDY 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 1 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 />COINER TORS LAW 1827 RCW AND ?96200 WAC. <br />1 <br />—_ <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />L T I D HUMBERA <br />PARCE/AJ <br />��i-Od <br />CONSTRUCTION LOAN LENDER. ADDEESS. 7ELLPHONE NUMBER <br />PROJECT ADiLD/RESS <br />—jI • <br />5'c 'I' DA" <br />CI flll$I4FSS lIC[NSt NO — <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET( <br />A'C—AIHNDLG UNITS—H.P. <br />_ <br />B)'.THTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY !WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />�T <br />BACKFLOW PREVENTERS <br />1L <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />T <br />SUBTOTAL <br />$ <br />SUBTOTAL_ $ <br />_ <br />PERMIT <br />$ <br />PERMIT $ <br />/S <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH ECK NU MRER <br />FEE <br />RECEIPT NO. <br />_ <br />35 <br />USE ZONE <br />1.01 AREA <br />VACANT SITE <br />L FEES <br />VALUATION <br />FEE <br />❑ YES - NO <br />BUILDING <br />TYPE Ot CONST <br />NO. OF STORIES <br />WUPAK <br />NO 0�D911LM4UNtTS <br />cNWP <br />PLUMBING <br />' <br />SIZE OF BLDG. FIRE SPRINKLERS REO'D BASEMENT <br />MECHANICAL <br />�— <br />❑ YES ❑ NO <br />OCCUPANCY l0A0 FIRE ALARM REOD HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />I ' <br />OTHER <br />I <br />T <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY PLANS APPROVED BY CITY OF EVERETi <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE TAX CODE IS 3105 <br />TOTAL <br />