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APPLICATIOfoo'N FOR CONSTRUCTI'`'M PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATINGSYSTEM: ❑ GAS ❑ ELECTRIC ❑ -- <br />BUILDING DEPARTMENT <br />259.8810 <br />✓ DEMOLITION COMBINATION 7 BUILDING a MECHANICAL PLUMBING f_l SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Ellen 4eddle o424 Beverly Blvd Everett gash. 98223 .rea Code 200 1;3-1372 <br />__...... ... mnnccR CITY ZIP PNONE <br />L-Inty <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />TV ZIP <br />PHONE STATE LICENSE• <br />GENERAL CONTRACTOR <br />MAIL ADORESC." <br />owAer <br />G4Z4f",L_r <br />y �� <br />nwTuc STATE LICENSER <br />F� <br />D <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP PHONE STATE LICENSE. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />SIX Q <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 />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />TWO COPIES) <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />9)1 t Pi nphuret. Lliv. A- fifnl <br />LOT 75 BLOCK �-- of <br />t <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />tone t her with that portion South Vacated <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 AND 296.200 WAC. <br />FPARCEL TAXI NUMBER <br />_ <br />� <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />ADDRESS <br />C <br />CNAIURE DME <br />.1 RVCHANICAL4f N0 <br />;PROJECT <br />2503 o2nd St. Everett. n.Of ddwav 3c 1V of ih <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />N0. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A)C—A)HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATER:,—B.T.U. Al <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />RANGE HOOD <br />_ DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY <br />WOOD STOVE ' <br />CLOTHES WASHER <br />METAL FIREPLACE (WOOD BURNING) ' <br />URINAL <br />FIREPLACE INSERT ' <br />_ DRINKING FOUNTAIN <br />HEAT PUMP ' <br />FLOOR DRAIN <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />EXHAUST FAN ' <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR. ETC.) <br />1 <br />- <br />' <br />T <br />' <br />SUB TOTAL S <br />PERMIT S <br />SUB TOTAL $ <br />PERMIT E <br />TOTAL FEE E <br />TOTAL FEE 8 <br />FOR OFFICE USE <br />ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN cHELK N BE <br />USE TONE <br />LOT AREA <br />VACANT SITE <br />F ES <br />❑ YES L: NO <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />TYPE BF CONST <br />NO OF STORIES <br />aCNEANC+ KO a DATwNG UNIR <br />BABEMENT <br />SIZE OF BLOO <br />FIRE SPRINKLERS REO'O <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RE00 <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />INTAKE By <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />GATE <br />a <br />