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APPLICATII# FOR CONSTRUCTYN PERMIT <br />TO BE COMPLETEC IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC O <br />259-8810 <br />❑ DEM LI 10 ❑ COo-M�BINATION �jC BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />ONNEfl FOGRE^,.`J CITY ZIP PNONE <br />Ti o tj_ 6LJ G/<4ss ,7 f v 4« 4< /oao i�� �'�i<. Q,F 339-o?sou <br />ILNANi I MAE ADDRESS CITY ZIP PNDNE <br />*ozcw G/ss S''4 . A< <br />r T <br />ARCHITECT OR DESIGNER MAILVDRESS NONE <br />4/AIE %B]SC778-9f3o <br />fO <br />GENERALCONTRA/CT�OR M 4 ESS CRY ZIP PROBE STATE LICENSE• <br />WEST L..A> ';;X,C,e , fo/O�/ /fvt lflar WESYGSPi2oJG <br />MECNANICALCCNTRACLOR MAILADDRESS CITY U<kP ���PNpYNE STATE LICENSE <br />9 7'os7 <br />PLUMBING CONTRACTOR MALLADDRESS CITY ZIP PHONE /a-sSTATp OENS[ E, <br />Opt MCl PRK:E OF Wdll( <br />E �35000 <br />FE DEBLRRE WpIK AND SDUARE FCOIAGE INVOLVED & <br />T RSONANDP IE 1q <br />of 7y�-sas7 <br />I HEREBY CERTIFY THAT 14AVE 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 T M THE WORK FOR WHICH <br />APPLICATION IS M AND I DOM Y WITH THE STATE <br />CONTRACTOR'.0.27 RCW AND2 .200 AC. <br />suAnrv, DATE <br />PROPOSED USE OF BU4DWG <br />O ♦/NS <br />LEGAL DESCRIPTION OF PROPERTY (SHOMN NEWORATTACH Tyro COPIES) <br />KLor E/ 2 BLOCK OF <br />e <br />AVA✓xl ml bW ! NE 4, StL /O Z.01 2<J/I <br />`7 n <br />R� F �/�/ (S63J f/Av�1fJE <br />A �— <br />PARCEL TA D,VuueER S <br />j' T�o6j <r/, ,',�-,.$'E, /✓M, .�io <br />CGNSTR KKI LOAN LENDER. ADDRESS. TEL PHONENUMBER <br />- /�� - Dolma <br />PROJECT ADDRESS <br />iazo /off P� ec LY/ c aJ- <br />pT.P (5PL P Y <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—AMNDLG UNITS—H.P <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 />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />H <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />I <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE-8AR, ETC.) <br />i- <br />SUB TOTAL $ <br />SUB TOTAL $ <br />_ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />N�� <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCHECKNUMBER <br />LEE <br />Ica. oS <br />RECEIPTNO <br />/GYJ' <br />USE ZONE <br />U,N 7APE3 <br />LOT AREA <br />VACANTSITE <br />❑ YES A NO <br />FEES <br />VALUATION <br />FEE <br />BmLDtNG <br />PLUMBING <br />TYPE OF WNST <br />NO OF STDRIEs <br />OM <br />Aon <br />BUT OF OEM <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />q-� <br />❑ YES p NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />-- <br />OCCUPANOYlOAO <br />rly.uDNt <br />FOIEALARMAEOD <br />NEIONTLWRATK)N <br />OTHER <br />REASON �1P��� <br />Gf O7rM <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANSAfPROVEDBY <br />vM <br />DATE }; <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOS IS im <br />PUBLIC WORKS <br />�l <br />TOTAL <br />�a ; �- <br />