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I <br />APPLICATICI FOR CONSTRUCT'7N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATINGSYSTEM: J GAS J EL ECTRIC J <br />259-8810 <br />MOLITION CI COMBINATION YJ BUILDING CI MECHANICAL ❑ PLUMBING L5 SIGN <br />OWNER' MAIL ADDRESS CITY ZIP PHONE /Z�G 13S-S-7�`.0 3 LiV) <br />-177,Vi5r 8• P.2;s70AI SzoS- 3-YAD AcIE (,c ?d�oc)3 4('z )— 3v?-oc/r;, <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAI'_ADDRESS CITY ZIP PHONE <br />coc, 14 <br />G ERAL T9ACTOR MAIL AD SS f CITY ZIP PHONE STATE LICENSE a <br /><ru�/> / �i /irk �� ,r _ ice :� �i�iir�aaa�� /la �f�'��fJ 1''fl'C/�rD�d� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CQLI-llZIP <br />PHONE <br />STATE LICENSE A <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE. LICENSE N <br />CONTRACT PRICE OF WORK n/�//// /,��1 <br />/_ &1 <br />rr- <br />DESCRIBE WORN AND SQUARE FOOTAGE INVOLVED <br />ENG�n_r Lr t�xTirv.l <br />CONTACT PER ON AND PHONE NO. <br />R'CH3iGu o �3 <br />TO A15y cf - <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 />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 />- <br />VATURE <br />PROPo USE OF BUILDING <br />LEGA SCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH 73I <br />LOT J/ BLOCK of 'e7197 pf! <br />PAR�C,I_AK LL En -GD 2 -G3/ -GCS <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />ffO <br />20 J <br />ATE <br />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 />I <br />UNITS-H.P. <br />BATHTUB <br />YSTEMS-B.T.U. M E.A.LAVATORY <br />_ <br />( SH BASIN) <br />NCED <br />S-B.T.U. M <br />SHOWER <br />ERSKITCHEN <br />SINK & DI <br />FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOO URNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />-T <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />' <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE US9 ONLY: 4�- 70T70 VY 44/ 7 <br />FRUNT S BAC <br />REAR SETBACK <br />SIDE SETBACK <br />7 �/ <br />PLAN CHECK NUMBER <br />. <br />FEE <br />I-� ; <br />RECE T NO. <br />US�= <br />LOT AREA <br />VACANT SITE <br />YES >CNO <br />FEES <br />VALUATION <br />FEE <br />BUILDING( <br />PLUMBING <br />_ <br />(� <br />- <br />�Z) <br />TYPE OF CONST. <br />/ <br />11 <br />NO. OF STORIES <br />I <br />GCCUPANCY <br />GROUP <br />NO Of MELLING UNITS <br />SIZE OF SLOG. <br />cf J s b <br />FIRE SPRINKLERS REO'D <br />(� <br />BASEMENT <br />Cl YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />— <br />, <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />e <br />HEIGHT LIMITAT7 <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />�— <br />INTAKE BY <br />PLANS APPROVED By <br />DATE v ��/f3 <br />CITY-0 EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />1 TOTAL <br />7 :, i& <br />