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APPL C''_W _J FOR CONSTRUCT_JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS <br />❑ ELECTRIC <br />❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION <br />❑ COMBINATION <br />❑ BUILDING <br />❑ MECHANICAL I& PLUMBING 1 SIGN <br />OWNER <br />TZOSSLtna� <br />MAIL ADDRESS <br />PQ Rc�T <br />CITY <br />11�2 %�k `'t WA <br />ZIP <br />Rg 729�1 <br />PHONE <br />2 si 2— k3 Chi <br />UXIii Stti <br />TENANT <br />Jam,.�� �Cm�wluSSn� <br />MAIL ADDRESS <br />HO05 <br />CITY ZIP <br />-tbt+^ �yeve crJ a`h1Ck <br />PHONE <br />�,9-Orr��v <br />, <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />OITY ZIP PHONE STATE LICENSES <br />MECHANICAL CONTRRAC OR MAIL ADDRESS CITY ZIP PHONE STATE LICENSES <br />PLUMBING�RACCTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEg <br />Uk Q vAA <br />CONTRACT PRICE OF WORK <br />1500. <br />DESCRIBE WORK ANDSQUAREFOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />0j`� �l L"I� V J7' v Lvc UI �Z QCCouto <br />-U� -oacQ tO �tl �^ �'L'`'1O <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />O $ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGALDES RIPTIONOFPROPERTY (SHOWN BELOW OR ATTACH iWO COPIES( <br />UOT _I BLOCK �-�— OF I l l '/Cq tJ <br />NOT. <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />` <br />E L/QI �J4S �� �� (p J yQ Qq <br />7 <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />BY THE <br />9----�7 �- <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED <br />N <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 />/PARCEL5TA'L0. NUMBER <br />n /" <br />IQQNSTRU TIUN LOAN LENDER, ADDRESS, T LEPHONE NUMBER <br />r <br />lA A �� ➢ .._..ZC� G <br />�A OA <br />siLNnruRE Unr <br />PROJECT OADDRESS /1� <br />I�M �ru <br />CHYUUgNE55 LILENSLNO <br />t OC <br />�bO C W\ V I J <br />PLUMBING <br />URE <br />NO. TYPE OF FIXTOR ITEM FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P. <br />BATHTUB <br />; <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 & DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />Y <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />URINAL <br />' <br />I <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PHEVENTFRS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEA.DERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />' <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE <br />FRONT SETBACK <br />USE ZONE <br />ONLY: <br />REAR SETBACK <br />LOT AREA <br />SIDE SETBACK <br />VACANT SITE <br />❑ YES ❑ NO <br />PLAN CHECK NUMBER FEE <br />FEES <br />VALUATION <br />RECEIPT No <br />FEE <br />BUILDING <br />' <br />TYPE OF CONST <br />NO.OF STORIES <br />NIA <br />DIP <br />I P <br />HOAFVMLLINGUMTS <br />PLUMBING <br />� <br />MECHANICAL <br />' <br />SIZE OF BLDG. <br />64 S11G <br />OCCUPANCY LOAD <br />FIRE SPRINKLERS RED <br />�J <br />FIRE ALARM REO'D <br />LA <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />; <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />' <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVEDBY <br />jil <br />Dne� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />