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Iy APPLICATIC <br />I FOR CONSTRUCT )N <br />PERMIT <br />G TO BE COMPLETED IN BLACK INK -PLEASE <br />l� <br />PRINT <br />HEATING SYSTEM: GAS <br />❑ ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />)( BUILDING <br />MECHANICAL <br />i PLUMBING <br />SIGN <br />OWNER MAIL ADDRESS <br />i,Cic,I+.J�AG �nc//r 04", rll�o <br />CITY <br />t-V i-F�/'c�f, <br />ZIP PHONE <br />atd"D�i i _✓=-77i; <br />Vl/H [t�'✓ice <br />✓ri?��{'ti3. <br />TENANT MAIL ADDRESS <br />CITY <br />I° PHONE <br />ARCHITEC OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHUNI, <br />v}rn N".^'� �}f%'N��" <br />��I/T� <br />�;% Ila^2 h/�i"✓/if"-fibE�Or= <br />�t/c'/',E�T {f/r? <br />`��� <59 - 3/E>/ <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />�/- CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />T <br />/7/ <br />J[ <br />�f/1 f1--.d,2- 16 yk c <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />O CRY <br />ZIP <br />PHONE <br />STATE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE R <br />CLASS OF WORK <br />AI TCDATInkl <br />PrPAIR nFMOL ITION <br />I <br />WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Fg <br />PR,POSEDUSEOFBUILDING <br />HERE Y 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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <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 />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT RS L"27W.200 WAC. <br />1� <br />_ <br />f' Z <br />X <br />SI onrE <br />PROJECT ADDRESS <br />CITYBUSINF.SS L'.LENSE NU <br />iN /� � <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIC-AiHNDLG UNITS-H.P. <br />' <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 />; <br />VENTILATION FAN <br />T <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE , <br />METAL FIREPLACE & CHIMNEY <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />T <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PRE NTERS <br />GAS PIPING <br />ROOF DRAIN RAINLEADERS <br />' <br />EXHAUST FAN / <br />SINK (SERY(CE—BAR, ETC.) <br />I <br />/ <br />' <br />i <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />I'VFf Vrrm c UJG <br />FRONT SET BACK <br />7E ZONE <br />_ <br />vn�R. <br />REARSETBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />PLAN CHECK NUMBER <br />FEES <br />FEE <br />79.7. yP <br />VALUATION <br />RECEIPTNO. <br />3i93 <br />FEE <br />BUIL ING .`� <br />O o7. iOS <br />TYPE DF CONTS. ALLOYlABLE <br />TYPE Of CONST. ACTUAL <br />JL.Ev <br />MCUPANCv <br />110 Or D'A'ILLIN6 ,, <br />PLUMBING <br />' <br />—� <br />MECHANICAL <br />I <br />_T <br />SIZE OF PLDG. <br />3 <br />NO. OFSTORIES <br />1 <br />BASEMENT <br />Ya�;, <br />ADDITIONAL PLAN CHECK <br />�— <br />OCCUPANCY LOAD FIRE SPRNNLE;S RED HEIGHT LIMITATION <br />313 YF/F/s��� <br />REASON FOR SPRINKLERS <br />A fM v r <br />ILNYLAiv _ <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKSLOCAL <br />' <br />INTAKE BV <br />LLAN;S ROVE D BY <br />CITY OF EVERETT <br />SALES <br />TAX CODE IS 3105 <br />TOTAL <br />o7 �� S3 <br />I <br />