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APPLICATIOI FOR CONSTRUCT1 _ N PERMIT (* <br /> G 1 <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT i <br /> I <br /> y C� HEATING SYSTEM: U GAS U ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> y a 259.8810 <br /> 9 y y 1( I i DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> MAIL ADDRESS CITY iIP PIgNE <br /> �So7l <br /> TENANT AMB ADDRESS DITY ZIP PHONE <br /> y � <br /> ~ ARCHITEC ORDESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> CAI ~ S �41ecA a� � fjht, � 8�2- /72 <br /> QGENERAL CONTRACTOR MAIL ADDRESS CRY 21P PHONE STATE IICENSEF <br /> cI H ° ��n t1 tp�K n frL) r c. ho ei c —_�lZ�t m <br /> 'S � C7 MECHANICAL CONTRACTOR MAIL CSS CITY ZIP PHONE STATE LICENSE IF <br /> C1. f7 <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE IICEN4CI ' <br /> t y — <br /> H y c`LA44 of wonA <br /> ti 6 NEW ADDITION ALTERATION REPAIR I DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> 8 H — <br /> (] d U1 CONTACT PERSON AND PHOIE NO <br /> CONTRACT PRICE CF WdiN <br /> DESCRIBE WORK AND&WARE FOOTAGE INVOLVED <br /> F3 0 CA SL 17 <br /> PROPOSE D USE OF BUILDING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> 2 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTION OF PROPERTY ISIOWN BELOW OR ATTACH FOUR COPIFSI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOTBLOCK of Q/VJ7 I� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> I 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 /> 1 / PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> C I S7 / .c l P I f�f OWNER OF THIS PROPERTY TO PERFORM THE WOPK FOR WHICH <br /> T— APPUCATILN IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> PROJECT AODREES 6aNnu.n / DATET <br /> 33 -Ga �� s <br /> CPLUMBING MECHANICAL"1 L ND <br /> R► N0, TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE R <br /> WATER CLOSET(TOILET) /4 AC—AHNDLG UNITS—H.P. <br /> w� <br /> BATHTUB FORCED AIR SYSTEMS—R.T.U. M E.A. <br /> ' LAVATORY(WASH BASIN) — UNIT HEATERS—B.T.U. M i <br /> SHOWERCLOTHES DRYERS <br /> _ I <br /> KITCHEN SINK 8 DISP — 3 VENTILATION FAN ' <br /> DISHWASHER I RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WASHER S" WOOD STOVE I _ <br /> URIN L ' METAL FIREPLACE A CHIMNEY — <br /> DRINKING FOUNTAIN , FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS I EXHAUST FAN <br /> _ SINK(SERVICE—BAR.ETC.) ' <br /> T <br /> I <br /> SUBTOTAL S SUBTOTAL f <br /> PERMIT $ PERMIT f <br /> TOTAL FEE S ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REARSETBACK SIDE SETBACK PLANCHECKNUMBHI IIF III CEIPT NO <br /> use ZONE LOTAREA VACANT SITE FEES VALUATION FEE r� <br /> F7 9,1 BUILDINGi 6 I� <br /> TYPE OF CONTE.ALUNINLE TYPE Of CONST ACTUA RKLPMI[, Ao oRwlH iAClnn _ J/ 0 3 7 <br /> T'"R'� PLUMBING S� elo <br /> ,QE OF SLOG 3sx: NO OF STORIES BASEMENT MECHANICAL Idd <br /> Ess Fc r .�/ -- <br /> oCUPAICY LOAD FIRE SPRNKLERS BE= HEIGHT LIMITATIONADDITIONAL PIAN CHECK I <br /> .4- 19 p ASPRINKLER ' <br /> M ASON FOR SPRINKLERS - <br /> STATE BUILDING SURCHARGE <br /> nI fAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES ---T— <br /> %�� TAX CODE IS 3105 TOTAL <br />