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n @01161ICJ FOR CONSTPUCT'"1N PERMIT <br />O BE COMPLETED IN BLACK INK —PLEASE PRINT <br />OCT 141993 4� <br />BUILDIHEATING SYSTEM: LI GAS J ELECTRIC Lj <br />Qj���,�RQjTT <br />259-881(Public Works Dept. <br />C DEMOLITION <br />_1 COMBINATION <br />Ll BUILDING <br />I I MECHANICAL ❑ PLUMBING K_ SIGN <br />OWNER <br />3PTj Z. cZ. clh�pr <br />MAIL ADDflEsS <br />5Z; 't"&c <br />CITY <br />.4w� F��refi,<v� <br />21P <br />` ect <br />PHONE <br />(ZcG) 339-rS3i <br />TENANT <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />h, <br />p <br />3SLy Cui��� <br />f�c.e ,t Fri/, <br />I& <br />Mal- <br />(z06) 33S-sr3� <br />A^RRJHITECT OR DESIGNER MAIL ADDRESS c <br />/':i.Z/p2�7 J <'/✓lf/4/P Y'�/✓(A 2 %// <br />p CITY <br />/L1i'C'/C�=� !J✓KVif.4%/{L4� <br />zip <br />PHONE <br />GENERAL CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE STATE JCENSE• <br />42) mew <br />MrCHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE A <br />PLUMPING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE 4 <br />7TRACT PRICC OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />PERSONA P O <br />C D <br />.�.�,E'tL=1� 33^-55"3> <br />I HEREBY CERTIFY THAT 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. TI IE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORIT`• 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 />CONT CTORS LA RC W AND 296.200 WAC. <br />PROPOSED USE OF BUILDING <br />4 M!v O (T IL , c s , <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT— BLOCK OF <br />— <br />PARCEL TAXD. NUMBER <br />oo_- - <br />4riy—aJ�—oz 7 <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />s°' ° E DATE <br />crt R sw¢s ua rvs-Na <br />PLUMBING <br />M CHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-AJHNDLG UNITS- H.P. _ <br />BATHTUB <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 />_ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STO\ E <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 />I <br />SUB TOTAL $ <br />SUB TOTAL S <br />PERMIT IS <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE IS <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK��IEAPVTBACK ,-� .ASIDE SETBACK PLANCHECKNUMBLR FEE RECEIPT NO. <br />US ONE LOT AREA — VACANT SITE <br />_ 7 )III [I YES ❑ NO <br />NO. OF STORIES '-T <br />TYPE OF CDNS7. RLGIPAxGv xo oLLIB 0115 <br />GRWP <br />SRE OF BLDG. I FIRE SPRINKLERS REO'D I BASEMENT <br />❑ YES ❑ NO <br />OCCUPANCY LOAD I FIREALARMPEOD I HEIGHT LIMITATION <br />By PLANS AgP�pVEDBY CITY OFEVERETT <br />(J�1 LOCAL SALES <br />DATE ,QxZI/G} �' TAX CODE IS 3105 <br />1MITHGCC <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PABLIC WORKS <br />TOTAL <br />