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APPLICATI -N FOR CONSTRUC" ON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ,GAS ❑ ELECTRIC U __ <br />259.8810 <br />1 ' DEMOLITION COMBINATION BUILDING /,MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />irtb 311 KQC�a, Ayc 'Ts- ' 1 ? 71- ; <br />TENANT MAIL ADDRESS �CIITYY_ ZIP PHONE <br />ARCHITECT OA DESIGNER MAIL ADDRESS CITY -� ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CITY <br />Cuss of WORK <br />-p<NEW 1 I ADDITION 1 1 ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT I BUILDING RELOCATION <br />CONTRACT PRICE OF WORK ' ' <br />\) <br />Ll..L. � LNYs: F <br />CONTACT PERSON AND PHONE NO. 1 <br />CH_ F 1v n /Y j �) / <br />7)I LESSCRBFE�IWOORK AND SOUARE FOOTAGE INVOLVEDaT <br />`' T!- <br />PROPOSED USE OF BUILDING � T-- <br />F�7rITl L /��)CC <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 />CONTRA L;RS 18.27 RCW AND 296.200 WAC. <br />I <br />X <br />LEGAL DESCRIPTION OF P OPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOt BLOCK OF <br />ti311 <br />PROJECT ADDRESS /(A{� <br />_ ` <br />SN1rvnTl: �D IE� <br />C(TYRISINESSUCENSEN <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 />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <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 <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP Z — oIJ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />I <br />I <br />— <br />— SUBTOTAL <br />PERMIT— <br />$ <br />g.—_. <br />SUB TOTAL $ <br />PERMIT <br />TOTAL FEE <br />$ <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />NEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />lvGl7l, <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />TYPE OF CONTC. ALLOWABLE <br />TYPE Of CONS7. ACTUAL <br />xannxtr <br />xa aowluiNG UNrtE <br />raow <br />PLUMBING <br />SIZE OF BLDG <br />I40. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO D HEIGHT LIMITATION <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />�— <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVFO BV <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />