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APPLICATIO" FOR CONSTRUCTf'NN <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: a GAS J ELECTRIC ❑ <br />259-8810 <br />] DEMOLITION <br />1 1 COMBINATION <br />I I BUILDING <br />VMECHANICAL L) PLUMBING SIGN <br />OWNER �7 <br />Q✓.a'� <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />gar" <br />NMSb 5p,k.rj <br />e✓PEr-� <br />9Sz�,3 AS-1-/47N <br />TESANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY PP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />MECHANIC'CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />✓i�rn Suit 51 P.0-� (toB ��+:+H U2 6 zr2 <br />-1hN 'vt2G JI2)k7 <br />PLUM INGCON TRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />CONTRACT PRlICYE OF WORK <br />ycSf7�,Oy <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSOFMND PHONE <br />(r <br />ay i rY l'rn �Tr- I'il-JI FN <br />II G 11 <br />C INN wn „7 1 HrnAEt � yN✓T '� i]q1 <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 />PROPOSEEnD� USE OF BUILDING <br />1`aSNj PA at <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT BLOCK OF <br />--- <br />— <br />PARCEL TAXI D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS I <br />N S3gV Nfy <br />scNauB - n+rz <br />CIIV BUSMESSLICLNSL 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 />A'C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />( <br />FORCED AIR SYSTEMS—B.T.U. <br />LAVATORY (WASH BASIN) <br />UNIT FEATERS—B T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />VENTILATION FAN <br />_ <br />KITCHEN SINK 8 DISP <br />_ <br />DISHWASHER <br />RANGE HOOD <br />T <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />2 <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />' <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />%O <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />i <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAP SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBFVRI <br />FEE <br />RECEIPT NO <br />qtf, /0, <br />USEZONE <br />LOTAREA <br />_ <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />YES ❑ NO <br />BUILDING <br />TYPE OF CONS(. <br />NO. OF STORIES <br />BGcu�NNty <br />NO NRYEUIxGUNUS <br />BPpi1° <br />PLUMBING <br />' <br />I <br />S1ZE OF BLDG. <br />FIRE SPRINKLERS RECYD <br />BASEMENT <br />MECHANICAL <br />I <br />YES ' ': NO <br />-- <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REDO <br />HEIGHT LIMITATION <br />OTHER <br />' <br />REASON <br />�— <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />