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APPLICATIC-1 FOR CONSTRUCT )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING x SIGN <br />OWNER MAIL ADDRESS <br />cXlt / r/iys-T C�fi1% <br />�UgMnl <br />CITY <br />"r <br />GVAJ <br />ZIP <br />lyL(5 <br />PHONE <br />3 S� Yr33 <br />TENANT <br />f Przza <br />MAIL ADDRESS <br />91oc:) <br />CITY <br />u SFL <br />Fur <br />ZIP <br />PHONE <br />T _ <br />ARCHI SIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACT1 <br />S <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE R <br />MECHANIC NTRACTOR <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE STATE LICENSE e <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE IF <br />CLASS OF WORK <br />MFw � AnnITlnM <br />I AI TFRATInN <br />REPAIR <br />DEMOL-ITION <br />WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />&00' DU <br />CONTA`/CT PERSON AND P ONE NO <br />9 may, <br />Srnl,: 2�Qo <br />CONTRACT PRICE OF WORK <br />�SGN <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />��yA�glBL <br />k1> 14,ge> I nn/ Ace <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PT22A n,1 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR <br />COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK OF <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 />✓ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />�_ _ _ <br />D <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />r,,. / L /2,7/9z <br />X <br />PR ECT ADDRESS <br />SIGNATURE DATE <br />F <br />Ao �` <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 />' <br />A/C-A/HNDLG UNITS-H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & CIS P <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />_ <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />' <br />I <br />' <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />11 1.1C ^Kie V. <br />rvn We. .vim ..vim <br />FRONT SETBACK <br />54 <br />USE ZONE <br />....� • . <br />REAR SETBACK <br />t A <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />PLAN CHECK NUM ER FEE <br />FEES <br />r <br />VALUATION <br />flECEIPT NO. <br />FEE <br />BUILDING <br />' C <br />-?/ <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OCCUPANCY <br />GROUP <br />NO OF OWEUt' UNITS <br />PLUMBING <br />' <br />MECHANICAL <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO'D HEIGHT LIMITATION <br />I <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />' <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />I G -�, JM <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />p <br />O <br />