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APPLICATIC� FOR CONSTRUCT�)N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEAT!NG SYSTEM: ❑GAS l.l ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8870 <br /> I I DEMOLITION I i COMBINATION f+� BUILDING � I MECHANICAL �'PLUMBING f 7 SIGN <br /> OWNtR qc <br /> MAI�PUOFESS CITY ZIP PNONF <br /> /C Pt/�� �YOSS �`J�30 ( rv �ncsoo /!io a//_10�1 - <br /> TEVANT 1AAI�ADOFESS CITY ZiP PHONE <br /> ARGMITECT OR DESIGNER MAIL f.��RESS CITV ZIP PHONE <br /> C ff�G r� <br /> GENERALCONTflACTOR � /MAILA�DRESS <br /> CITY ZIP PNONE STATEUCENSEb <br /> i� L°us�a.s, f7a� s /7o�-o�c..i U�a�J �-,U �!/air7/ 4�Zo3 3�/7i37,Y l7eL.eoc�iJE1 <br /> QLPOn PNONE SiATGUCcYSEI <br /> MECHANICALCONTflACTOR MAILAODRESS ��TY Z�P <br /> PUIMBMGCONTRACTO� MAILADDPESS <br /> CITV ZIP PHONE STA"E LICcNSE M <br /> CONTRACi Ff110E OF WOHN <br /> 13 0�� <br /> DE^uCR19E�D SOUARE FOOTAGE�INVOLVE� COHTACT PERSON ANO PHON�NO. <br /> �Soo SF � aO � <br /> :f<� _ � ' � � <br /> �, � I HEREBY CERTIFV THAT I HAVE READ ANU EXAMINED THIS <br />�IF t SEo:��.�r,o:e,�o��� / APPLICATION AND KNOW THE SAME TO BE TRUE AND CGRRECT.ALL <br /> I PROVISIONS OF LAWS AND ORDINANCES GOVEFiNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPR PEPNISHOV BELOWORATTACNTWO OPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> p�Q,F r� L�/�-� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or 1 �' � e�ock 5� oF p AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> UD( 3 3 2 �er� �IS �..ol, �o��..YS OTHER STATE OP. LOCAL LAW REGULATMG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PpqCEL iAX I.D.NUMBER CONTRACTORS LAW 18,27 RCW AND 296200 NlAG � <br /> 017� c�a>,� pn�c I f'�.. V�c �'hAF"lA� er13�J > <br /> �.�.5 �lot� �39/ 'Sfi+S " 239 �s34b <br /> CO`�SiRUCTION LOAN LENDER.ADORESS,TELEPHONE NUM9ER X��L�. � <br /> �� 0 iE <br /> � SkNf�II�E <br /> PROJECT ADDRE S +h <br /> / � t GITYNUSINESSLICENSENO <br /> PLUMBING MECHANICAL <br /> FEE N0. TYPE OFE�UIPMENT FEE <br /> NO. TYPE OF FIXTURE OR ITEM �— <br /> Z, WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—FI.P. ' <br /> Z BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> z LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ' <br /> L SHOWER ' CLOTHES DRYEPS � <br /> Z KITCHEN SINK&DISP � VENTILATION FAN � <br /> i � RANuEHOOD � <br /> •-- DISHWASHER � WATER HEATER <br /> — LAUNDRYTRAY � WOODSTOVE ' <br /> _ CLOTHES WASHER , METAL FIREPLACE(WOnD BURNING) ' <br /> URINAL _ ' - — ' <br /> DRINKING FOUNTAM � FIREPLACE INSERT � ' <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING __ ; <br /> ROOF DRAINS—RAINLEADERS � � EXHAUST FAN _ ' <br /> � <br /> � <br /> SINK(SERVICE—BAR,ETC.) <br /> — � _ � <br /> � <br /> — , <br /> — -- � � <br /> -- � -- <br /> SUB TOTAL $ ' SUB TOTAL $ � <br /> PEPMIT $ � PERMIT 8 ' <br /> TOTAL FEE $ ' TOTAL FEE 8 ' <br /> FOR OFFICE USE ONLY: RECEIPTNO. <br /> 51�:SETBACK PLAN CHECK NUMBER FEE <br /> FPONT SETBACK REAR SETBACK � /� <br /> FEES 7 VALUATION FEE <br /> USEZONE LOTAREA VACANTSITE — /.��; D� <br /> L YES ��l ND BUILDING �� l�aZ� <br /> i <br /> TYPE FCONST. ^10.OFSTORIES O[GqPAxv NOo�m'lEuinGUNnS �v . D� <br /> �_ � ��� '_�z— PLUMRMG _�— <br /> MECHANICPL ���� � �J, <br /> SIZE OF BL�G. FIRE SPRINK�ER$REO'D BASEMENT _ <br /> �'� ND ❑ YES G NO - . 3 � LOG� <br /> HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> OCCll2ANC�'LQpO FIRE ALARM FE�'0 � <br /> �a GvJ O1HEFi <br /> REASON ,�qTE BUILDING SURCHAFGE �/ 'S;� <br /> INTAKE 6V PLANS A P OVED BY CITY OF EVERETT PUBLIC WORNS � <br /> a�q LOCAL SA�ES v �SS <br /> I TAX CODE fS 3195 T�ir^� — <br /> nnTe <br />