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APPI_ICATIO FOR CONSTRUCTr N PERMIT <br />TO PE COMPLETED IN BLACK INK —PLEASE PRINT ��I/wT <br />BUILDING DEPARTMENT HEATING SYSTEM: m GAS 'J ELECTRIC <br />259-8810 <br />DEMOLITION I I COMBINATION I I BUILDING <br />pYPIER MAIL ADDRESS CITY <br />c�;c Slr�oyer isa0 <br />IAR 'Jd^—a <br />TENANT - C.� rrlji <br />LADDRESS <br />J <br />% MECHANICAL PLUMBING SIGN <br />ZIP - <br />`% Ao3 PHDNE353-961,Z <br />TIP PNONE <br />ARCHITECT OR DESIGNER <br />.-_ <br />MARADORESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />PHONE <br />_ <br />STATE LICENSE <br />[:R MAR ADDRESS CRY Zlp <br />i PHONE STATE LICENSE <br />_— MAK AGGRESS CITY 21P PIgNE <br />STATE LICENSE � <br />CONTRACT PRICE OF WO BL <br />DESCRIBE WORK AND SOLARE FOOTA3E INVOLVED <br />PROPO/JSED US/En�OF BI1R DING <br />LEGAL DESCRIPTION OF PROPERTY ISIIOVVN BELOW OR ATTACI <br />LOT RLOCK _J4 OF <br />JGriC i�v A���L�.l <br />003 —L700 t <br />I PARCELTAX ID NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBE <br />PROJECT ADDRESS <br />_ PLUMBING — <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB E— <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CONTACT <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 />WORK WILL DE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI. THE PROVISIONS OF ANY <br />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 AND 296.200 WAC, <br />L <br />TYPE OF EOUIPI <br />:HNDLG UNITS—H.F <br />:D AIR SYSTEMS—B <br />EATERS—B.T.U. M <br />ES DRYERS _ <br />ATION FAN <br />HOOD <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK BEAR SETBACK <br />SIDE SE79ACK <br />PLAN CHECK NUMBER TEE RECEIPT NO <br />UBE 2011E LOTAREA <br />TYPE OF CDNSt. NO OF STORIES <br />VACANTSITE <br />IF, YES i� NO <br />a54MlapWll�F4U4i16 <br />AON <br />FEES VALUATION FEE <br />BUILDING <br />- <br />PLUMBING <br />SIZE OF BLDG FIRE SPRINKLERS REDD <br />BASEMENT <br />;-i YES l ! NO <br />MECHANICAL <br />)CCUPANCY LOAD FIRE ALARMREOD <br />HEIGNTLIMRATION <br />ADDITIONAL PLAN CHECK <br />I <br />OTHER I <br />IEASON <br />STATE BUILDING SURCHARGE I <br />VTAKE BY PLANS APPROVED BY CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS 1 <br />TOTAL <br />DATE TAX CODE IS 3105 <br />