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APPLICATIGA FOR CONSTRUCT waN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT OOL <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: ITf GAS <br />❑ ELECTRIC <br />❑ <br />259-8810 <br />1.1 DEMOLITION <br />COMBINATION <br />!1! BUILDING <br />L! MECHANICAL <br />OWNER <br />MAIL ADDRESS <br />1-1 PLUMBING ❑SIGN <br />�RLCJ dr✓r@5 Ih'L <br />37�I7�iixi'InXe <br />CITY <br />RJ@ C C, � �, �€3A$In <br />ZIP <br />PHONE <br />TENT iQI <br />MgIL ADDRESS <br />�7f1D1 <br />3Z5�' �77D <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />I <br />PHONE <br />GENERAL CONTRACTORi <br />MAIL ADDRESS <br />CITY <br />ZIP <br />ME6ilANICAL CONTRACT R <br />MAIL ADDRESS <br />ws <br />CITY <br />ZIP <br />(.J L <br />PHONE <br />Z <br />STAT (CENSER <br />OL <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />j ADDITION ALTERATION <br />--- - - - ---•••-•-• <br />• •�• ..vvuo I vvCmHHL INSERT BUILDING RELOCAi ION <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE <br />i� ,r/e Jim ��L^ Q <br />/TO /—("�/T-{i <br />WORK AND SQUARE FOOTAGE INVOLVED <br />LI J ru <br />ED <br />_,./ <br />USE OF S LDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />_YYI!l[/ dot <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LE..., . ESCRIPTION OF PROPERTY (SHOWN BELOW <br />OR ATTACH FOURCOPIES) <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LOT�BLOCK OF F• 3Q,��2 <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />I�(� <br />��5� //L i �� DT �YO•f�� :oi <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO OR CANCEL THE SIONS OF ANY <br />/i -' <br />OTHER STATE ORVLOCAL LAW REGULATING CONSIOLATE <br />TRUCTION 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. Q <br />SC iBBU �1),� " 6 <br />ATG E — <br />PROJECT ADDRESS <br />7/14 !//1 mere' <br />�J <br />CITY <br />BUSINESS LICENSE NO <br />T <br />PLUMB NG <br />MECHANICAL <br />NO. <br />NO. <br />TYPE OF FIXTURE OR I TEM <br />FEE <br />1;4 <br />WATER CLOSET (TOILET) <br />TYPE OF EQUIPMENT <br />FEE <br />02 <br />BATHTUB <br />A/C-A/HNDLG UNITS-H.P. <br />3 <br />LAVATORY (WASH BASIN) <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />SHOWER <br />UNIT HEATERS-B.T.U. M <br />_ <br />KITCHEN SINK & DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />, <br />RANGE HOOD <br />LAUNDRY TRAY <br />, <br />CLOTHES WASHER <br />; <br />WATER HEATER <br />WOOD STOVE <br />URINAL <br />DRINKING FOUNTAIN <br />; <br />METAL FIREPLACE 8 CHIMNEY <br />FLOOR DRAIN <br />FIREPLACE INSERT <br />BACKFLOW PREVENTERS <br />' <br />HEAT PUMP <br />ROOF DRAINS-RAINLEADERS <br />; <br />GAS PIPING <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />, <br />, <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />CAD nrml�� <br />FRONT SETBACK <br />USE / <br />REAR SETBACK <br />LOT AREA <br />SIDE SETBACK <br />S� <br />VACANT SITE <br />PLAN CHECK NUMBER F(EE. //� <br />35736 3 = <br />FEES VALUATION <br />RECEIPT NO <br />l7I <br />FEE <br />BUILDING <br />O <br />G <br />l <br />TYPE OF CONIS ALLOWABLE <br />. / <br />TYPE OF CONST. ACTUAL <br />OCCUPANCY NO.Oi BWFIIING IIMNS <br />PLUMBING <br />B�IyZ.�E OF BLDG. <br />/ fi& 7- Y�v <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />OCCUPANCY LOAD <br />cr— <br />FIRE SPRNKLERS REO'D <br />HEIGHT LIMIFATION <br />/ <br />ADDITIONAL PLAN CHECK <br />i <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE BV <br />PLANS APPROVED BV <br />CITY OF EVERETi <br />LOCAL SALES <br />PUBLIC WORKS <br />' <br />TOTAL <br />TAX CODE IS 3105 <br />