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APPLICATI(" 1 FOR CONSTRUCT' -IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC U <br />259-8810 <br />C DEMOLITION (/!COMBINATION ❑ BUILDING ] MECHANICAL I 1 PLUMBING ❑ SIGN <br />N <br />R gtti� �'tnLtic, 50/? <br />ul'I <br />33Ao Ev. <br />ZIP <br />9$2'03 <br />PHONE <br />0)- j'O - g? 2-q <br />TENANT MAIL ADDRESS <br />IL w • CITY <br />ZIP <br />PHONE <br />ARCHITECTORDESy�NER MAIL. ADDRESS <br />�►-yo+t tin -4(7-4 <br />CITY <br />s 3au Evr <br />ZIP <br />' <br />PHONE <br />:2- $3? L <br />-�mo <br />GENERR L C��GfN�TFACTOR MAIL AD I SS <br />IL �ySTr`� <br />CITY <br />TK, <br />ZIP <br />PHONE <br />STATE LICENSE 0 <br />)Au< N omc5 <br />103y IV, 9 NlK <br />OR EL,T <br />992o3 <br />7-5V-1.95b //4tV5on93zE <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />Pt�tu,,.M �Lvw.aw,A <br />CITY <br />ZIP <br />PHONE STATE LICENSEp <br />C-A--�)II.n <br />CONTRACT PRICE OF WORK <br />Dnt.Lq�j G-. L4ets„� �sYt-2-gSn <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />Z-Auo��10H5 �o P�x�STt <br />LOAJ <br />ZOd �P Rx' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />CWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT((��''''pp�1''CTORS LAW 18.27 RCW ND 296.200 WAC. <br />r ' <br />xYl//n\v`/'I <br />PROPOSED US'::F BUILDING <br />SI 11 Y <br />LEGAL DESCRIPTIONOF PROPERTY ISH WN BELOWORATTACH TW 4TCLLOPIES1 <br />LOTL9 BLOCK OF NORtL �rCtZ,�i A005�1 <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTIOfIOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />SD; (/j 33Ro <br />�E <br />SIGNATURE DATE _ 3 <br />S // <br />DIiYRUSINES$LICERSFNO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET)7i <br />A/C-FUHNDLG UNITS-H.P. <br />BATHTUB <br />IFORCED <br />AIR SYSTEMS--B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.TIJ. M <br />If <br />SHOWER <br />CLOTHES DRYERS <br />�— <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOT"HES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />_ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />REC PT NO <br />Coy&(o <br />USE ZC�E,� <br />'( <br />LOT AREA <br />VACANT SITE <br />;?'NO <br />FEES <br />VALUATION <br />FEE <br />DYES <br />BUILDING <br />Z 4[1 <br />- <br />TYPE OFCONST <br />NO.FSTORIES <br />PLUMBING <br />SIZE OF BLUG. <br />21 I 5,` <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />- <br />' <br />p <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />A00710AI <br />Al <br />OCCUPANCY LOAD <br />FIRE ALARM REDD <br />HEIGHT LIMITATION <br />I AJIA <br />/+ <br />OTHER <br />T <br />REASON <br />— <br />STATE BUILDING SURCHARGE <br />C1 <br />INTAKE BY <br />PLANS APPROVED Ea <br />JJ({ <br />CITY OF EVER ETT <br />LOCAL SALES <br />PUBLICWORKS <br />4— <br />TOTAL <br />DATE S�2b/�j <br />TAX r9GE IS 3105 <br />B <br />