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APPLICATIC 1 FOR CONSTRUCT )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />259-8810 <br />DEMOLITION COMBINATION I I BUILDING i I MECHANICAL PLUMBING SIGN <br />ONIILR MAIL ADDRESS CITY ZIP PHONE <br />('TLra owEtlLAM LpwM 'P.ie &cVc5TT Wo-z, 3w-4,N36 A" - 4,wpl <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNLR MAIL ADC 7ESS CITY ZIP PHO'IE <br />GENERAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE STATE LICENSE <br />;7REC� IJ'lEf,:j8R06LC jaCiXjc I- <br />MECHAN TRACT Q MAIL ADDRESS ff CITY ! ZIP PHONE STATE LICENSE <br />PAWBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE& <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />NEL.o czw-x%,I,1Inv, tzran <br />e <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 />RGSR.6-� <br />PROVISIONS OF LAI S AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COmPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGALDESCRI ION OF PROPERTY (SHOWN! BELOW OR ATTACH TWO CO IES) <br />5/ <br />NOT. THE GRANTING OF A PERN;IT DOES NOT PRESUME TO GIVE <br />Lor BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />-- <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />'—" <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />/� - <br />-- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAX 10 NUMBER <br />Cx, wt uoc <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONENUMDER <br />PROJECT ADDRESS <br />�� <br />SCNMUNE c+ E <br />���� � _ �l' / �� <br />LHV BuiiN65 uO as1 •m <br />MECHANICAI. _ <br />_PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />{r <br />AIG—FIHNDLG UNITS—H.P.BATHTUBFORCED <br />AIR SYSTEMS—B.T.U. M E.A.LAVATORY <br />(WASH BASIN) <br />PFEENO.TYPE <br />-($UNIT <br />HEATERS—B.T.U. M <br />SHOWER <br />2. <br />CLOTHES DRYERSKITCHEN <br />SINK 8 DISPVENTILATION <br />FAN <br />DISHWASHER <br />RANGEHOOD <br />.m <br />LAUNDRY TRAY <br />i <br />WATER HEATER_ <br />CLOTHES WASHER <br />-6 <br />WOOD STOVE <br />URINAL <br />' <br />$- <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />$ <br />FIREPLACE INSERT <br />t� <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />_ <br />ROOF DRAINS—RAINLEADERS <br />I <br />I} <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR. ETC.) <br />I <br />' <br />I <br />' <br />I <br />I <br />' <br />' <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />; <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />FRONTSETMCK <br />�f <br />•REAR SETBACK <br />'AIcAa. <br />SIDE SE IB�CK <br />PLAN CMEC NUMBER <br />%l <br />FEE <br />30 <br />RECEIPT NO <br />USE 7 E <br />�TES <br />Z_ <br />LOT AREA <br />8o'8 <br />VACANT SITE <br />,f� NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />�$1 3y <br />7 ,S <br />TYPE OF COfl9 <br />NO OF STORIES <br />s <br />acuwAc+ <br />° <br />No aOWLUINC WITS <br />Z <br />_ <br />PLUMBING <br />I <br />MECHANICAL <br />tod ' <br />SIZE OF BLDG <br />f <br />FIRE SPRIN LERS REDO <br />BASE_M•yEo; <br />94ES I:: NO <br />ADDITIONAL PLAN CHECK <br />' <br />^_ <br />OCCUPANCY LOAD <br />A <br />H' <br />FIRE ALA M <br />ED0 <br />HEIGHT LIMITATION <br />�q ) <br />(ice/ <br />OTHER <br />i OLD <br />REASON <br />STATE BUILDING SURCHARGE <br />� SRI. <br />INTAKE BY <br />PLANSAP ROVFOOv <br />DATF 53 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />Ut od <br />TOTAL <br />