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APPLICATION FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 0:77 <br />BUILDING DEPARTMENT HEATING SYSTEM: W GAS ❑ ELECTRIC ❑ <br />259-8810 <br />I DEMOLITION I I COMBINATION JX BUILDING MECHANICAL I:ILUMBING P <br />OWNER MAIL ADDRESS SIGN <br />Daily Homes, Inc. 3240 Eastlake Avenue Eery Seattle, Z198102 PHONE <br />TENgNT MAIL ADDRESS (206)328-3770 <br />CITY ZIP PHONE <br />ARCHITECT ORDESIGNER IAAIL ADDRESS <br />CITY ZIP PHONE <br />Same as above <br />MAIL ADDRESS <br />CLASS OF WORN <br />IX NEW I I ADDITION I I ALTERATION <br />Single Family �' <br />PROPOSED USE OF PJILDING <br />Residence <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN <br />LOT I_ BLOCK <br />See attached <br />TYPE <br />tl- <br />8 DISP <br />OF <br />5 <br />ATTACH <br />PHONE STATE LICENSE A <br />V"Y ZIP PHONE <br />STATE LICENSE A <br />CITY ZIP PHONE <br />STATE LICENSE If <br />I ----------------- <br />I REPA'R I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />Ron Pearce 252-9098 <br />T Jim Schmidt 328-3770 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OUR COPIES) 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 96.200 WAC. <br />TYPE <br />�cu H1116Y51=MS—BT.U. M E.A. <br />UNIT=ATERS—B.TB.T--- -M _ , <br />CLOTHE RYERS <br />VENTILATIO N ,— <br />RANGE HOOD -�--- <br />WATER HEATER — <br />DRINKING FOUNTAIN <br />METAL FIREPLACE 8 CHIMN <br />FLOOR DRAIN <br />; <br />FIREPLACE IN <br />INSERT <br />' <br />_ BACKFLpW PREVENTERS <br />HEAT PUMP <br />ROOF DRAINS—RAINLEADERS <br />' <br />GAS PIPING <br />SINK (SERVICE —BAR, ETC.,) <br />I <br />EXHAUST FAN <br />- SUB TOTAL <br />$ <br />_ <br />PERMIT <br />$ <br />SUB TOTAL <br />$ <br />TOTAL FEE <br />$ <br />PERMIT <br />$ <br />---T <br />FOR OFFICE USE ONLY: <br />TOTAL FEE <br />$ <br />FRONT SETBACK REAR SETBACK <br />Ate' <br />/ �O <br />SIDE SETBAC% <br />P AN CHECK NUMBER FEE <br />RECEIPT NO. <br />' I� <br />USEZONE LOT AREA <br />VACANT SITE <br />) <br />il. ��Cl <br />3 <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONTS. ALLOWABLE TYPE OF CONST. ACTUAL <br />rtcunuxr xn wPwLUlxn urns <br />BUILDING <br />MV <br />OR <br />SIZE OF BLDG. NO. OF STORIES <br />I6IG r <br />B SEMENT <br />PLUMBING <br />' <br />L <br />"40 <br />MECHANICAL <br />I <br />OCCUPANCY LOAD FmE SPRNKLERS REDO <br />HEIGHT LIMITAT N <br />i <br />ADDITIONAL PLAN CHECK <br />y_ <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />I <br />SEATE BUILDING SURCHARGE <br />—i— <br />� <br />INTAKE BV PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />Lll ;G <br />9Z JM <br />TAX CODE IS 3105 <br />TOTAL <br />/ <br />