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APPLICATIC 1 FOR CONSTRUCT' IN PERMIT <br />P� TO BE COMPLETED IN BLACK INK -PLEASE PRINT *;:rr <br />HEATING SYSTEM: ❑ GAS AELECTRIC J <br />BUILDING DEPARTMENT <br />259.8810 <br />11 DEMOLITION X COMBINATION I I BUILDING I MECHANICAL i, PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />Ai-.Y A) hbow5 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />OR DESIGNER MAIL ADDRESS &J/nl <br />ZIP .,HONE <br />UENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br />ALMA) HUMS 54110 1W*h Pi -SE JEC999T 91,009 837-9-17.2 ALyLh4&cegApr <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br />Ole N <br />PL G CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />iy� A/_ APrAi lrr 1fAj"p;rAIr_ <br />TRACT PRICE OF W RK <br />DEWRIBEWORK AN 1 RE FOOTAGEINV <br />TACT PERSON AND PHONE NOOr"•, w37-,S�ry4 <br />`� <br />y L <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 />_ <br />!y."!AXILE F jiy a <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />ft LY �F o�p•� <br />T2"}= <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT +�! - BLOCK �r��� <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGL:'ATING CONSTRUCTION OR THE <br />G�+ A ���/pG <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />EQL1Cy <br />O NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />9309/05 I}CGGeQ fi 7b P /p <br />_ O <br />AP LICATION IS ADE AND I COMPLY WITH THE STATE <br />Cp"9ACTORSLA 10.27 W AND296.200WAC39.20-000- <br />PARCEL' AX 10 NUMBER <br />03A-070% <br />^ - - D"IL :�93 <br />CONSTRUCTION LOAN LENDER.A DRESS IELEPHONE NUMBER 7 S-5'"�r <br />PROJECT ADDRESS <br />(oNi, 5r SE COFF tart PLC <br />ev. <br />_- <br />- - <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 />^ <br />A/C-A/HNDLG UNITS-H.P. <br />7- <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />/ <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />- <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />( <br />I <br />I <br />' <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />.-.nv ..nw v. <br />rvn v.. wr AA <br />FHONT SETBACK <br />v..�.. <br />REAR SETBACK <br />SIDE SETBACK <br />A <br />PLAN CHECK NUMBER FEE <br />''� �/2•�5 <br />RECEIPT NO <br />c <br />�b S <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />r <br />F5`Z�L <br />7 ES ❑ NO <br />BUILDING <br />79 Lrj(e <br />TYPE Oi NST <br />NO OF 5TORIE5 <br />OUVFSNO' <br />A'f a O'MUIMG VInE <br />"+�' <br />PLUMBING <br />) <br />MECHANICAL <br />' <br />SIZE OF BLDG. t <br />SSff <br />FIRE SPRINKLERS REO'D <br />BASEMENT / <br />ADDITIONAL PLAN CHECK <br />IE GAIL <br />YES '.L�NO <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />OTHER DOA) <br />D <br />A <br />_N <br />REASON <br />STATE BUILDING SURCHARGE <br />I �D <br />INTAKE BY PUNSAPPFI VEDBY CITY OF EVERETT <br />PUBLIC WORKS <br />Q LOCAL SALES <br />IS 3105 <br />TOTAL <br />DATE l y� Z�q T TAX CODE <br />0 <br />