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APPL'."40"ATICA FOR CONSTRUCTIN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: � GAS ❑ELECTRIC O _ <br />BUILDING DEPARTMENT <br />259-8810 <br />Li DEMOLITION 1 COMBINATION .a BUILDING FI MECHANICAL El PLUMBING ❑SIGN <br />OWNER <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />p 3�2 <br />3 2 �s�-/d 4 c <br />/igsc <br />28*a o 3 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />13/d5 <br />e,. <br />ARCHITECT RDESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />3�3 /{ll <br />Q/� <br />09 /CJerT <br />li'erT+ FJ <br />gg�o3 <br />�S� 33J� <br />l� �c P l3 <br />r <br />LNERALCONTBACTOFI <br />CITY <br />ZIP <br />PHONE <br />uTATE LK;ENSEA <br />MAILADDRESS <br />Z <br />MECHANIC"TRACTOR TRACTOR <br />MAILADDRESS <br />Fill <br />ZIP <br />PHONE <br />STATE LICENSE <br />"S <br />ArI 4,1✓nl {J <br />`_CIITY <br />5-n 6 <br />1 <br />PLUMBING CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CONTRACT PRI E3F WORK <br />DESCRIBE WORK l NO SQUARE FOOTAGE 111OLWO <br />CONTACT PERSON AND PHONE NO <br />L. Ek. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />o <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEG�.NCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) <br />�e <br />PERMIT S TO VE <br />NOT ISIONS <br />ANTING OF AOR <br />THE RTO <br />LOT .2 BLctKQ 0,—1i-u--�- <br />OF ASUME <br />AUTHORITY YT. <br />VIOLATE CANCELHE PROVS NY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />n /"1 <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 />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS \ <br />see .rune T oerE <br />ill <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />r <br />A'C-AIHNDLG UNITS-H.P. <br />- <br />1 <br />/ <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />.2 <br />BATHTUB <br />(WASH BASIN) 1 <br />'y i <br />B <br />UNIT HEATERS-.T.U. M <br />_LAVATORY <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP ' <br />7 <br />VENTILATION FAN <br />DISHWASHER <br />% <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />/ <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />•� <br />GAS PIPING <br />i <br />BACKFLOW PREVENTERS <br />ROOF DRAS-RAINLEADERS <br />IN <br />' <br />?j <br />EXHAUST FAN <br />' <br />-- <br />SINK (SERVICE -BAR, ETC.) <br />, <br />1 <br />T <br />1 <br />1 <br />I- <br />1 _ <br />SUB TOTAL S <br />' <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: 'V 69T' Gy I—— `_ <br />FRONT SETBACK <br />0 <br />USE ZO <br />BEAR SETBACK <br />LOT AREA <br />-V � Qp <br />SIDE SETBAACK <br />VACANTSITE <br />YES ❑ NO <br />PLAN CHF_CK BE R FEE <br />FEES <br />oO <br />VALUATION <br />RECEIPT NO <br />BUILDING <br />1 Q3 A{q <br />rFEE /� <br />� ") i�� L <br />TYPE OF CON57. <br />NO. OF S OR <br />o[CUN.N[v <br />RO+IP <br />J <br />NO OT PMIIINS UNITS <br />( <br />PLUMBING <br />7� <br />MECHANICAL <br />�, <br />O - <br />SIZE OF RLDG -}- <br />264o S f GpR <br />FIRE SPRINKLERS BEOD <br />Np <br />DASEME T <br />ES ❑ NO <br />ADDITIONAL PLAN CHECK <br />- <br />T� <br />OCCUPANCY OAD <br />FIRE ALARM REGO <br />U <br />HEIGHT LIMITATION <br />T <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGEJa <br />� <br />PUBLIC WORKS <br />INTAKE BY <br />PLANSAPPROVEDBY CITY OF EVERETT <br />J t LOCAL SALES <br />DATE <-/,7.A-7 TAX CODE ;S 31OF <br />' TOTAL <br />7& i 7&1 <br />