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APPLICATIO�N F�R CONSTF;UCT_�ON PERMIT � <br />TO BE �uMPLETED IN BL,4CK INK—PLEASE PRi�. i <br />�HEATING SYSTEM: J GAS ❑ ELECTRIC U_ <br />BUILDING DEPARTMENT <br />259-8810 <br />I I DEMOLITION I I COMBINATION I✓BUILDING IH�MECHANICAL <br />OWNER MAI�A�DRESS GITY ZIP PMONE <br />(� �'!�' l <br />I - ScI'luo� 1Sl�� I•�JKA/1 ��' ��� �ri��'r G�N /.S,r /J 33 � <br />TENANT IAAILA�ORESS CITY ZIP PHONE <br />AflCNITECTORDE5IGNER h1AILADOflESS CITV 21P PHONE <br />CONTRACi PRICE OF WORK <br />DESCRIBE WORK 4ND SOLA <br />MAIL �DOflESS <br />156 - o /i;; �'c c <br />MAIL ADDfiESS <br />s n��t ��. <br />MAIL hP^RESS <br />INVOLVED <br />PPOPOSEO � E OF �UILUIN� �/ � <br />f�✓,�p .�.:. i! ... <br />LEGaL DESCRIPTI OF PROPERTY �SNOY� <br />�or � 3�o�K <br />, . C-ar��C.ai✓ <br />PFRCEL TA% I.D. IlU1A0Efl <br />CITY <br />S�oh. c.,� %' <br />CITY <br />� <br />� �., w� r <br />CRY <br />..�-«-W..-.: <br />�` � <br />GONL�CT <br />CN�LUMBING �I SIGN <br />21P P/10NE STATE UCENSE e <br />i��; i 33y-�8/9 RA I o Ns oG.�,4'I I <br />ZIP PMONE ST �E LICENSL k <br />sa�� �s �� ��� (�'FR;F; ;�a�,c.�6 <br />ZIP PHONE STATE LICENSE P <br />98ar� �n>(%'r/�l/% � ��/cl7 �(J ����� <br />��I��>/-�- 5��� It 331/-d8i7 <br />�ER5011 AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATIOh AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />� o PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYFE OF <br />LOWORATT�CHTWOCOPIES� WORK WILL BE COMPLET[D WITFI WHETHER SPEGFIE� HEREIN OR <br />oF ��� j1"� ' S' ('�,I NOT. THE GRANTING OF A PERMIT DOFS 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 PERFOFiM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 19.27 RCW AND 296.200 WAC. <br />CONSTRUCTION LOAN LEN�ER, AODRESS. TELEPMONE NUTA�ER <br />PROJECT ADDRESS /� <br />///Jo I7'- I.� <br />PLUMBING <br />NO. TYPE OF PI%TURE OR ITEM <br />� WATEFl CLOSET (TOILET) <br />2 BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />( KITCHEN SINK 8 DISP <br />I OISHWASHER <br />LAUNDRY TRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />'i�CKFLOW PREVE�JTERS <br />i � :.rGF DflAINS—RAINLEADERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSEfBACN REARSET�ACN <br />� Zo" <br />USE Z LOT AREA <br />�-3 �s�9 <br />7YPEOFCONSI NO.OFSTORIEB <br />-�t . � � <br />SIZE OP BL�G FIPE SPRINNLERS flE0'D <br />iZ90 SF'r <br />4v� SP GAQ <br />OGCUPANCY LOAD FIRE ALAP1.1 PEO � <br />A � <br />flEASO4 <br />INiAKE BY PLANS APPFOVcD 6Y <br />J <<<G G <br />DATE 2 / / // 5 <br />FEE <br />N0. TYPE OF EOI�IPMENT <br />A�'C—A/HNDLG UNITS—H.P. <br />� FOACED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />J WATEfl HEATER <br />WOOD SiOVE <br />METAL FIREPLACE (WOOD BUHNING� <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />SIDE SETBACN PLAN CMECK 1lUIddER FEG <br />5' �j�,�9j �O <br />VPCANTSITE FEES �A� <br />[��ES ❑ NO BUILDING � <br />atuvau[r riD orDW[LLir:co9�rs <br />PO1P PLUMBING <br />a.3 <br />BASEIAENT ��� MECHANICAL <br />i:�! YES '��'NU <br />MEIGHT LIAtITATION ADDITIONAL PLAN CHECK <br />/ <br />Z OTHER <br />STATE BUII.DING SURCHAFGE <br />CITY OF EVERETT PUBUC WORKS <br />LOCAL SqLES <br />TCY f.(lOF IS 3105 TOTA� <br />FEE <br />5 <br />S <br />5 <br />REC/EIPT N0. ) <br />/ �����J/ <br />FEE <br />—�T <br />o ; � <br />i n: <br />