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APPLICATIC : FOR CONSTRUCT"IN PERMIT'- TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC 7 <br />BUILDING DEPARTMENT <br />259-8810 g� <br />DEMOLITION I 1 Ml`� �w•�'T�blr'ir3�7►�WICl a�f6R g4Affl lijJJj&LUMBING SIGN <br />NEq MAIL ADDRESS TiF' <br />vIL� �uKi <br />1 �-Po 98d7s � s a83 <br />TENANT h-, O� C PHONE <br />ARCHITECT.Ofl DESIGNER —.MAIL-ADDRESS <br />___CITY. .__--ZIP <br />_ _ _ <br />,_ PHONE <br />-77 'IMLL — <br />GENERAL CONTRACTOR <br />GENERAL <br />MAILAODRESS <br />_ <br />CITY <br />ZIP <br />� TE LIC SIG <br />339 NO3HO NAJ'-I (A) _ <br />GHANICAL CONT Aq1-TrOPR� <br />,MAIL ADDRE55 <br />— <br />CITY <br />ZIP <br />O <br />PHONE <br />�a� <br />STATE <br />�L�GC'r MaU�k9� <br />-.)Cut/ <br />Cp <br />LIiS�ytn)s, <br />( <br />Ncnixr>•-�x x T <br />LU I GGONTRACTOR---- <br />LAODHESS <br />GIN <br />ZIP <br />PHONE <br />STxIpP,lY1BNIM P.V�]m LEI <br />CONTRACT PRICE OF WO <br />3000 DMIOJIUE (A) <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />_ -- — - --- -- <br />CONTACT PERSON AND PHONE NO 3000YaR3N3 (B) <br />Q! <br />TIMR39'fAW3VIR(3 (a) <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROIPOSED U E`OF ItolNc <br />p^P/t��{�_TFf?9�I`3$LAfi��IR�D. <br />33?I Y)OF <br />WORK WILL BE COMPLETED WITH WHETH H E OR <br />NG0TWQ8WI9Q0EIA'BBBMpIIWISMPMOWgAp GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />HOMI-__—_--_. <br />LOT BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />VI <br />I7/b0Wi ESfAaldWEb7aNNIl�3SA*GULATING.CONSfi�11CiIljD�RRy THE <br />- �_.OVt <br />PERF---- <br />OF <br />JHH <br />' (4 I <br />OWNER OFNCE <br />THIS PROPE}1�F"pggW XY <br />I�,i LIGATION IS MA7`�� (7I COMPLY WITI,S�STATE <br />127 296.200 WAL- <br />PARCEL TAX 10 NUMBER W <br />2 N <br />CONTRACTORS LAWiB RGW AND <br />CCNSIRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PR E A ESS <br />LLICtNSENO <br />PLUMBING-- _-- - -- - - - --- -- <br />NO. - - ----TYPE OF-FIXTURE <br />FEE <br />M <br />lid <br />ICAL <br />3?., TYPE OF E'OUIPMENT FEE — <br />WATER CLOSET (TOILET) <br />kHNDLG UNIT;:-H.P. <br />-SATHitiB=- <br />' <br />RCED AIR SYSTEMS-B.T.U. <br />-- <br />fJ T <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B. i.U. M <br />T <br />CLOTHES DRYcRS <br />SHOWER <br />• <br />MOD <br />TION FAN <br />� <br />KITCHEN SINK 8 DISP <br />DISHWASHER___ -_ ___ N <br />URT _ <br />_ <br />FAM(iN000 <br />_ <br />LAUNDRY TRAY <br />_ T - HEATER <br />- <br />-- <br />-CLOTHES WASHER---- <br />23 <br />T <br />RAHO 1AQITD <br />LilAO <br />TOVE <br />�F1T1C9TIREPLACE(WOOD BURNING) <br />..URINAL. -.. _... ._—._—._ <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />T <br />HEAT JMP <br />BACKFLOW PREVENTERS <br />ING <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />T <br />I <br />T <br />EXHAUST FAN <br />T <br />T <br />T <br />SUTOTALSB <br />' <br />SUB TOTAL $ <br />$ <br />T <br />PERMIT $ <br />PERMIT <br />TOTAL FEE S <br />TOTALI $ <br />FOR OFFICE USE <br />ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USEZONE <br />LOTAREA <br />TYPE OF CONST. <br />NO, OF STORIES <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RED <br />MCNPANCV LOAD <br />FIRE ALARM REGD <br />SIDESETBACK <br />PLAN CHEC NUMB n <br />VACANT SITE <br />C1 YES ❑ NO <br />FEES <br />BUILOING <br />ocua l <br />GAWP <br />No IN lM ULINU ITS <br />PLJMBING <br />MECHANICAL <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OTHER <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />By A­RLANSVED BY CITY OF EVERETT PUBLICWORKSLOCAL SALES TAX CODE IS 3105 TOTAL T <br />