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APPLICATIC) FOR CONSTRUCT_ <br />JN <br />PERMIT <br />TO BE COMPLETED IN FLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSI EM: ❑ GAS ELECTRIC <br />❑ <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL <br />PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY iIP <br />PHONE <br />�yr <br />Al, =05're[ca. P/ /(!� Gsg��,� '/60^ <br />334 -57`[-t' <br />414, <br />TENANT MAIL ADDRESS CITY 71P <br />PHONE <br />ARbHITECT OP DESIGNER MAIL ADDRESS CITY ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />PHONE <br />STATE LICENBx — <br />SAMLS �c'CEyt j 41n11UE NC` PI4R-gSUlQE` QA 9Sd'70 <br />4S')• <br />-DR <br />ME�CHA�NIC(A/LrQ��P <br />I�gC�T�O�a.�i ILADDR <br />AD <br />5 CITY ZIP <br />PHONE <br />STAT�LICENSE0 <br />=�4L4LL`to <br />//JI��'/AIL <br />/Ql\ _�2 <br />PLUMBING CONTRO CTOR MAIL ADDRESS CITY ZIP <br />PHONE <br />STATE LICENSE 0 <br />CLASS OF WORK / <br />NEW L- ADDITION ALTERATION REPAIR nFMnI ITION wnnncTnrc,vool <br />- <br />CONTRACT PRICE OF WORK 1`��CIL, EJ <br />� AJ �%0 <br />CONTACT PERSON AND PHONE NO. ^ <br />J�f �c�s� �S 1� c. L1c. i..o <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />IfJ'1c c F><IST ST 45 1 ADO <br />NIA rzwti c <br />-a I­LkI <br />PROPOSED USE OF BUILDING <br />ID C, Pt p, Y /2*,&/ TA <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 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 />CONTRACTORS LAW 18. RCW AND 296.200 WAC. <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT__ BLOCK _ OF <br />Szi- � III ��. L <br />�� < gAlAl �y S�# s� <br />rx //���I - rr <br />PROJECT ADDRESS <br />St • BT LATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />^ <br />WATER CLOSET (TOILET) <br />vI <br />cJ <br />A/C-A/HNOLG UNITS-H.P. <br />_ <br />BATHTUB <br />0 <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />X (� <br />UNIT HEATERS-B.T.U. M OcC pp rr <br />C) <br />SHOWER <br />CLOTHESDRYERSS <br />KITCHEN SINK & DISP <br />0 ; <br />VENTILATION FAN <br />L <br />DISHWASHER <br />RANGE HOOD <br />0 <br />LAUNDRY TRAY <br />2 <br />WATER HEATER <br />i, <br />CLOTHES WASHER <br />A I <br />v <br />WOOD STOVE <br />o <br />URINAL <br />ei <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />U <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />o <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />) <br />GAS PIPING <br />A' <br />ROOF DRAINS-RAINLEADERS <br />g <br />EXHAUST FAN <br />- c <br />SINK (SERVICE -BAR, ETC.) <br />I <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />i <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: � /Q R I-) <br />FRONT SETBACK <br />LQ' <br />REAR SETBACK <br />Lo` <br />SIDE SETBACK <br />5' - lo' <br />PLAN CHECK NUMBER <br />AEE <br />-231 `0 <br />RECEIPT NO <br />p 20 <br />USE ZOIL__ <br />l- <br />LOTAREA <br />zoo <br />VACANT SITE <br />So <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />a' <br />TYPE OEC Nis Al101YABLf <br />�. <br />TYPE OF CONSLACTUAL <br />OCCUPANty <br />Bp" <br />xa 010WBUHGuxaS <br />PLUMBING <br />71 <br />SIZE OF SLOG <br />CEM 3 <br />NO OF STORIES <br />2-I <br />BASEMENT <br />`/o <br />MECHANICAL <br />I <br />ADDI"IONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO'D HEIGHT LIMITATION <br />No <br />REASON OR SPPIN LETS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />,C/ <br />INTAKE By <br />rinrls aanaovEo BY CITY OF EVERETT <br />LOCAL SALES <br />J} 7 2Q TAX CODE IS 3105 <br />PUBLIC WORKS <br />C <br />iOTAL <br />rf <br />