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APPLICATIGA FOR CONSTRUCT.JN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS (] ELECTRIC U <br />259-8810 <br />i DEMOLITION L I COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Diz <br />! /rhvmes 3Zy� E ZaA AtAl�' <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />G NERALCONTRACTOR MAIL ADDRESS CITY ZIP PHONF STATE LICENSE <br />lww %1omeS �1r*T2- <br />CH IC LC !'TRACTOR M LADDRESS CITY ZIP PHONE ST 'E LICENSEa <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSEt <br />�C�L/pSSOFWORK <br />Y NFW I 1 ADDITInN 1 1 ALTERATION REPAIR I DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATIO" <br />i <br />CONTRACT PRICE OF WORK /OV <br />CONTACT PERSON AND PHON tJO. -Tl�- ^ • �— <br />CO \ /T/ <br />DESCRIBE WORK AND SQUARE FOOT E INVOLVED / ��+ 1 . <br />-nr1�c l -�A� zrr > , w- T <br />K <br />PRO SEDUSE OF BUILDING <br />I- 11 <br />�bMp�e {e. QAT. <br />1 <br />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 />x <br />SIGNATURE once <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIE;.) <br />LOT.- BLOCK of <br />327 - y y <br />PROJECT ADDRESS <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A.- <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />_LIP <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I ev <br />I <br />' <br />I <br />I <br />I <br />' <br />SUB <br />I <br />SUB TOTAL $ <br />&c) 'dZ) <br />PER; $ <br />PERMIT $ <br />t <br />TOTAL FEE $ <br />TOTAL FEE $ <br />Ono nccinc I IQc nmI V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />/�L3-7zG <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE Of CONST ACTUAL <br />D""cr <br />NO m DA.... Nt urvrtS <br />tnouv <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />�eJ ' !/L/ <br />ADDITIONAL PLAN CHECK <br />i <br />I <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />I <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />I <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />i <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />;(j?> <br />