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APPLICATIO► FOR CONSTRUCTI _,N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLFASE PRINT <br /> BUILDING DEPARTMEIIT CHEATING SYSTEM: GAS ❑ELECTRIC ❑___ <br /> 159 8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> �IkE ��aY�leP1 ��9 -*_ � E X222 A3 P3 .s - �S,Pz <br /> TENANT MAIL ADDRESS CRY #ZIP PHONE — <br /> ARCHITECTORDESIGNFR MAIL ADORE SS CITY Z PHONE <br /> GENUAL CTAACTC, MAIL ADDRESS LffY ZIP PHONE STATE LICENSE <br /> L�rysmucnnA> n7ls'OS 9�y'Li�A'� /y �dy py0� 9Ko zo 775-. ,OTC'o tJ** /3�4P, <br /> MECPr};A:Q CONT'a1GTOR MAK ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PCJMBINO CANTAACTOR MAIL ADORES9 CITY ZIP PHOV! STATE LICENSE/ <br /> CLASS OF WORK <br /> NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RFLOCATICN <br /> CONTA T PERSON AND PHONE NO <br /> CONTRACT PRICE OF WORK 7 �� <br /> DESCRIBE WORK ANDS .ARE FOOVAtE INVOLVED <br /> PROPOSED USE OF OUILDING I HEREBY CEPTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> LEGAL DESCRIPTION Ci PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT _ BLOCK mig or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AA,A, AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 04p_ -on 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 PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW ANU 296.200 WAC. <br /> 4 <br /> PROJECT ADDRESS <br /> e1�9 _ �•- Yr FnNATURE DATE <br /> �i / � �C // C�A CIITPUSnrt• . <br /> PLUMBING MECHANICAL -" <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) I AIC-A HNDLG UNITS-H.P. , <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE ' <br /> URINAL METAL FIREPLACE 6 CHIMNEY I <br /> _ DRIP:Y.INO FOUNTAIN FIREPLACE INSERT ' <br /> FLOOR DRAIN HEAT PUMP , <br /> BACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN , <br /> SINK(SERVICE-BAR,ETC.) , <br /> r <br /> , <br /> , <br /> i <br /> , <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ ; <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK, SIDE SETBACK PLAN CHECK NUMBER FEE REC IPT NO <br /> Za Zo S -58.3 9-3. &0 3.;)05;- <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> )� BUILDING <br /> TYPE 017WWWABLIF TYPE Of ONST ACTUAL Ett,KAFfr wdmYlulw uxn6 <br /> PLUMBING � <br /> SIZE OF BLDG. NO OF ST IES BASEMEN , <br /> 6 MECHANICAL , <br /> OCCUPANC LOAD FIRE SPRNKLERS REDO HEIGHT LLIMITATN)N ADDITIONAL PLAN CHECK <br /> u A� i <br /> SPRINKLER i <br /> REASON FOR SPRINKLERS , <br /> STATE BUILDING SURCHARGE ' <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS y <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL <br />