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APPLICATIC 1 FOR CONSTRUCT' )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS id ELECTRIC ❑ <br />259-8810 <br />I ' DEMOLITION <br />1 COMBINATION <br />JC BUILDING <br />MECHANICAL L PLUMBING LJ SIGN <br />OWNER / <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />5S�/r�35 <br />Pc dF <br />(Ai�ysoi� e <br />Gs�-/.261 <br />L <br />-TENANT / Q!J^ <br />SAIL ADDRESS <br />ZIP <br />PHONE <br />�A HITECTOR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />/'rl,lr <br />Sr <br />GNN ONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE# <br />-1)e <br />'JECAPONICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE# <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />C NTRACT PRICE OF WORK <br />q / �/,44 <br />DESCRIk WORK lND SOUAREF TAGE IN OLVED <br />57 Cr'Y <br />CO fTP SON AN PMON 0. <br />S - - <br />.��/.� <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 18.27 RCW AND 296.200 WAC. <br />(n/ <br />x F< r/9s- <br />SIGNATURE PATE <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) / <br />,n:��-T7CJ .S•(�lUi/t NYC},,. t1 <br />LOT BLOCK ---120 5— /OF Ifetk ,— <br />GD 5 l n !� �lO�f <br />PARCEL TAX LD. NUMBER <br />5-7: k-o os- .�D -0003 <br />CON TRUCTIONLOANLENDE R ADDRESS, TELEPHONENUMBER <br />Ps sum, -.l 77 -.7z/6S— <br />PROJECT ADDRESS <br />9;?0 / el,- zive- <br />CITY BUSINESS UCENSENT <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-A/HNDLG UNITS-H.P. <br />_ <br />BATHTUB <br />FOPCED AIR SYSTEMS-B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />Sh OWER <br />CLOTHES DRYERS <br />KITC N SINK 8 DISP <br />\ NTILATION FAN <br />_ <br />DISHWASl7f <br />RA E HOOD <br />_ <br />LAUNDRY TRA <br />41 <br />WATE EATER <br />CLOTHES WASHER <br />WOOD ST <br />URINAL <br />METAL FIREPL E (WOOD BURNING) <br />' <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSER <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />I <br />SIN.,,, (SERVICE —BAR, ETC.) <br />' <br />I <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />_ <br />PERMIT $ <br />PERMIT $ <br />i <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: 5T/. ;�_ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />FLANCHE KNUMBER <br />FEE / <br />5 <br />RECEIPT NO. <br />J��! , 7 <br />' <br />USE ONE L <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />/¢ <br />❑ YES ❑ NO <br />BUILDING ol. <br />'TZ <br />TYPE Of CONST <br />NO. OF STORIES <br />OCOIEANCY <br />N MMILIKUNGN <br />n <br />9-GRUMP1191 <br />I <br />PLUMBING <br />SIZE OF BLDG2' <br />� <br />FIRE SPRINKLERSREO'D <br />BASEMENT <br />MECHANICAL <br />i <br />.9 <br />u1 <br />r YES NO <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD <br />FIRE ALARM <br />ALARMREOO <br />HEIGHTLIM1TATION <br />A <br />OTHER <br />C— <br />�(� <br />OA <br />REAN6*01NAMI55F, <br />STATE BUILDING SURCHARGE <br />� �G <br />INTAKE BY <br />PLANS APP9O,,VED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />tIl"' <br />LOCAL SALES <br />OATS (o �) !� <br />TAX CODE IS 3105 <br />TOTAL <br />��� <br />