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APPLICATIC 1 FOR CONSTRUCT 3N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT nrnerr <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS <br />J ELECTRIC y7id <br />Un dG_ <br />259-8810 <br />_ DEMOLITION COMBINATION BUILDING <br />MECHANICAL <br />PLUMBING SIGN <br />O R MAIL ADDRESS CITY <br />ZIP <br />CoolF N22 ¢t� 13 <br />PHONE <br />a v SncApp"m <br />99e?90 <br />n CITY <br />PHLOiNEM <br />-TLE�N7A�1NTL�1�!_ <br />S✓QA,315f 5E_ JFVa # <br />94�OS <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSE <br />Dan .L <br />MECHANICAL CONTRACIOR MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSEI <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSE <br />I NEW ADDITION ALTERATION Jk REPAIR nPMnl ITInM U,n.,ncr....�,..,... ,.,..�.._ _.... _..._ __ <br />-- --' -- - - DUILUINU"LLLZUA I IUN <br />w. d <br />AND PHONE NO <br />Al1�toy, <br />CONTRACT PRICE OF WORK /i0� <br />ffe,vPERSON <br />DESCRIBE WORK AND SOLIARE <br />(ON <br />- Iyo scr airl <br />FOOTAGE INVOLVED <br />�G/S,% ner�Cji <br />PRO SEO USEOF UILDINO <br />z <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACHcoP1ESI <br />_FOU <br />,( <br />LOT J BLOCK of /4��/T/IhF <br />WORK <br />LURANTIINGP <br />_L/ <br />NOT. THE OF A RMIT✓DOES NOT PRIESUMETO GIVE <br />^ <br />ACCLYNu w A G pl�A i - <br />T <br />AUTHORITYII.S <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />,,A <br />IeCor4g( In „,�I,�.,t 4' Oi PI A <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />pC <br />,3114 f YGr n r f A/A�1C Jf yy <br />/L_• ` 92 <br />PROJECT ADDRESS <br />9 %2& Ii 3ral 5t SE <br />6xIDNAM1v,I „rl <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A "-A/HNOLG UNITS-H.P. <br />.ter_ <br />BATHTUB <br />F(1RCE6AIR SYSTEMS-B.T.U. M E.A. <br />I <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />I <br />, <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />I <br />-- <br />DISHWASHER _ <br />, <br />RANGE HOOD <br />' <br />, <br />I <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHESWASHER <br />I <br />WOOD STOVE <br />— <br />URINAL <br />' <br />METAL FIREPLACE 8 CH EY <br />DRINKING FOUNTAIN <br />, <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />i <br />GAS PIPING <br />, <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST F <br />SINK (SERVICE -BAR, ETC.) <br />-�-- <br />I <br />, <br />, <br />I <br />I <br />1 <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />PERMIT S <br />I <br />PERMIT $ <br />, <br />TOTAL FEE $ <br />' <br />TOTAL- FEE $ <br />! <br />VUH OFFICE USE ONLY: P ovin <br />FRONT SETBACK REAR SETBACK <br />USF ZONE LOT AREA <br />15 D6 <br />EG7o L.1 /Zio UBc. <br />e. <br />VALUATION <br />RECEIPT NO. <br />7171yvx <br />FEE <br />SIDE SETBACK <br />VACANT SITE <br />PLAN CHECK NUMBER FEE <br />3F <br />FEES <br />BUILDING <br />TYPE OF LONTS ALLOWA9lf <br />TYPE OF CONSi. AL1UAl <br />ufSaKANtr <br />AU pDM,DAGm UA <br />PLUMBING <br />-N <br />.3 <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />OCCUPANCY LOAD 17FIWSPITNKLER3 REOD <br />EIGHT (IMITATION <br />ADDITIONAL PLAN CHECKMIA <br />�6 19a <br />H <br />Nd <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />' <br />STATE BUILDING SURCHARGE <br />_ <br />CITYOF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I ' <br />i <br />INTAKE BY <br />_ <br />NANS APPROVEDOv <br />PUBLIC WORKS <br />TOTAL <br />