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APPLICATIC I FOR CONSTRUCT. )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT I HEATINGSYSTEM: UGAS ❑ELECTRIC U _ <br />259-8810 <br />L1 DEMOLITION N COMBINATION CI BUILDING I i MECHANICAL ❑ PLUMBING ❑ SIGN <br />EPANE4 Mn ADDRESS cm ZIP PONE <br />Jg A N4SSINF/1 1911 JT41r ST. /LI:% 6g 2 r 9&a/ ISL-079$ <br />%.ANT MAS ADDRESS CITY ZM PHONE <br />ARCNITECIORDESGNER MAIL ADDRESS CT ZIP vMnA <br />Chrr _ <br />ccufaAL CON1aAcrOR Mr"7Ess Cm ZIP PNDNf sTArE LE.SEA <br />l�AKi?N G�F� t(31.N/i/f&t2 1,15 FLkr-_,TT".5x+4E Lj 7�So II"wmc Io Ljooy <br />MEf ANCAL CMTRACl011 MA4 ADDRESS CRY 1 ZIP PHONE STATE MEN: PA <br />PLWBMGCWTPA.TOR WLADCPESS CIE, ZIP PKXiE STATE UlENSE0 <br />fIiVIA ktr_aA?!,se FLh.'Rd_rTLf//, 5rwo LSL-29E0 <br />CONTRACT PRIZEa WORK <br />559yv- <br />CESCR9fWCHKANpSQUARE 1AIE MV 1 <br />f• I� �n wi*SNr,'fr AA✓W 0�??/ L-"4 /r�r£c <br />fh%v I^+rA�vf-.t M�GG .Nn N'N� it <br />CONTACTPCRSONMIDPPOE NO <br />(ARR Y /✓� IL(jx/i LS L -14J <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 fRESUME 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 />/ / � (J>7 /J �J <br />PROPDsw USEOFBULomG <br />Rr- S/O fYC- <br />LEGAL DESCRIPTIOR DE PRDRERrrlsNovm BELowoR ArrACN TvrocooEsl <br />LDtI/ i I L 399 _ DR s r M�.R«-n` noo <br />PARCEL T/JI m. NIMBER <br />CdISTR1ILTCNIMNIENDER,Md1E55. TElEPIQE NINBER <br />PROJECT ADDRESS <br />19n J Ti1F s/ <br />- N <br />PLUMPING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A'C—AMNDLG UNITS—H.P <br />BATHTUB <br />FORCED AIR SYSTEMS—S.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.TU. M <br />5110WER <br />CLOTHES DRYERS <br />KITCHEN SINK 6 DISP <br />VENTILATION EAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <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 />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL E <br />PERMIT $ <br />PERMIT b <br />TOTALFEE b <br />TOTAL FEE $— <br />FOR OFFICE USE ONLY: <br />FRCNr SETBACK <br />REARSETI&I <br />SIDE SENACK <br />PANCNECKMIMBEP <br />TEE <br />RECEIPTNO <br />USE ZONE <br />LOTAREA <br />VACANT an <br />L] YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />8i DU <br />MEDE MYSi <br />NO OF STORIES <br />RAMP MMPWORtR.l <br />PLUMBING <br />7 iv <br />SIZEOFBEDG <br />FIRE SPRINKLERS REDD <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />OCCUPANCY LOAD <br />FPE ALARMREOD <br />HEIRHT LMWATKM <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />MAKE BY <br />RAHS APPROVED By <br />BATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PURL IC WORKS <br />TOTAL <br />I <br />