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APPLICATIC 1 FOR CONSTRUCT" )N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPT RTMENT HEATING SYSTEM: J GAS J ELECTRIC U <br /> 259.8810 <br /> DEMOLITIONCOMBINATION ,T( BUILDING )(MECHANICAL PLUMBING 1 SIGN <br /> OWNER .t / MAIL ADDRE 55 CITY IIP PHONE <br /> L04 --- <br /> TENANT lYADDL RESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAR ADDRESS CITY IIF PHONE <br /> Lt>110 Cpfj*4w6,ol of c�/o07 4�#Crass- slriiolU(UA We/ yefysyy __ --- <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE/ <br /> L o{v C�n,c{n�c�i'a , CCG p L DDcocie/S'y��11 <br /> MECHANICAL CONTRACTOR MAI.ADDRESS CITY IIP PHONE STATE LICENSE/ <br /> f.UMBING CONTRACTOR MAR ADDRESS CITY IIP PHONE STATE LICENSE■ <br /> CONTRACT PRIG OF WORK <br /> t30 7lalA _ _ -- <br /> DESCPIBE WORK AND SQUARE FOOTAGE INVOLVED M w CONTACT PERSON AND PHONE NO _3310 <br /> �1 j' Z� 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIDW ' nn APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S I y l G !A..�C,/ JCyl/ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCRIPTKMI OF PROPERttt BELOW OR ATTACH TVO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT f BLOCK OF P° AN/ "' AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> /�a If �/v OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> /V ! C. PERFORMANCE OF CONSTRUCTION.THAT 1 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 /> PARCEL TAN G D NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,ADDRESS,TELEPHONE NUMBERL3/,9 <br /> PROJECT AD/D�RESS �`' /_ S ) s wt_/(�, �,� C �cl PIIS ViI'ININiI <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET( AIC—AIHNDLG UNITS—H.P. — <br /> BATHTUO FORCED AIR SYSTEMS—B.T.0/OO,M E.A. <br /> S LAVATORY(WASH BASIN( UNIT HEATERS-81M M <br /> SHOWER C CLOTHES DRYERS <br /> f KITCHEN SINK A DISP VENTILATION FAN <br /> DISHWASHER I RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) — <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN I HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> FINK(SERVICE—BAR.ETC.) ' <br /> I <br /> I <br /> _T <br /> 1 <br /> SUB TOTAL A SUBTOTAL $ <br /> PERMIT S I PERMIT E <br /> TOTALFEE S TOTAL FEE $ <br /> FOR OFFICE USE ONLY: 'L �S '3`� <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK 7,S d' PIAN CNE KNIIMBE FFA/� �� R7� <br /> 12 .5 A ( /rP.M Wm 10, M NC.?>r % VALUATION FEE <br /> USE ZONE LOT AREA VACANT SITE FEES <br /> S pSpr'-7 VES ❑ NO BUILDING ;),g> <br /> IYPT OF CONST NO OF STORIES O[NOAK[r MG pfMIUAq VpitF <br /> n AO1J� I PLUMBING <br /> !i c�^� <br /> ZOF VRL FIRE SPRINKLERS PEO) BASEMENT MECHANICAL ' <br /> 733f G J VESO <br /> OCCUPANCY LOAD FIRE ALARM REDO HE UHT LIMITATION ADDITIONAL PLAN CHECK <br /> Iff zvU / OTHER ;I �n l� U (1 <br /> REASON a <br /> STATE BUILDING SURCHARGE It <br /> INTAKE BY PLANS APP OV 0BY CITY OF EVERETT PURI Ic WORKS U i d <br /> J LOCAL SALES <br /> DACE TAX CODE IS 3105 TOTAL d ger ;(n •Z <br />