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APPLICATIG _ J FOR CONSTRUCT. JN PERMIT <br />TO DE COMPLETED IN BLACK INK—PL :ASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ELECTRIC ❑ <br />259-8810 <br />DEMOLITION <br />X COMBINATION <br />BUILDING <br />MECHANICAL PLUMBING SIGN <br />OWNER <br />��L�r-2r <br />MAIL ADDRESS <br />CITY <br />`464 <br />ZIP PHONE <br />111, <br />fgI,n-s 146-7 <br />9gEo� as 062� <br />TENANT <br />MAI ADDRESS <br />CITY <br />TIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />PLUMBING CONTRACTOR MA L ADDRESS CITY ZIP PHONE STATE LICENSE A <br />._.__.,....,.... <br />i I NEW j( ADDITION X ILTERATION REPAIR nrUnl ITInu <br />^' <br />A( dor <br />.. .-.-. ... .. ...��• uuLVmV IICLVVM11V1Y <br />CON TACT PE RSON AND PHONE ND <br />CONTRACT PRICE OF WORK <br />DES F, WORK AND SQUARE TAOE INVO.VED <br />�55 <br />PROPOSED� USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />IA,ESE DCMCE <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 (SHOWN BELOW OR ATTACH FOUR COPIES) <br />ft <br />LOt�_ pLOCKQne D-ffor Q40LCOA AfAove <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />_ <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 LAB` 18.2 RCW AND 296.200 WAG, <br />' <br />PROJC 7ADDRE59 h4l <br />51r.NM,mE <br />01T <br />�-) <br />E,Tr BUSMf KS l �'f NSE Np <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />Z <br />WATER CLOSET (TOILET( <br />, - <br />AIC-A/HNDLG UNITS-H.P. <br />Z <br />BATHTUB <br />Q' - <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />4 <br />LAVATORY (WASH BASIN( <br />, - <br />UNIT HEATERS-B.T.U. M <br />; <br />( <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK d DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />—�— <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />, <br />' <br />FIREPLACE INSERT <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />, <br />SINK (SERVICE -BAR, ETC.) <br />' <br />, <br />T— <br />I <br />SUB TOTAL $ <br />, -- <br />SUB TOTAL E <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTAL FEE S <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBA17 <br />PLAN CHECK NUMBER 81� <br />sag <br />FEE <br />54/ <br />RE IPTNO <br />USE Z <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />JIM <br />_ 4(� VCJ <br />TYPE OF LONTS ALLOWABLE <br />E <br />TYPE OF CONS) ACTUAL <br />,90,Lf <br />,ICCVVMxr <br />r P <br />Iq pOAEwNG,AnE <br />PLUMBING <br />I EOFB <br />NO OF STORIES <br />1 <br />BASEMENT <br />ND <br />MECHANICAL <br />OCCUPANCY LOAD FIRE 6PRNKLERS RE00 NEKLHTfLIMfIT�AT'ON <br />� <br />`v <br />REASON FOR SPRINKLERS <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />, <br />STATE BUILDING SURCHARGE <br />PUSLIC WORKS <br />�-:— <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TOTAL <br />C J <br />TAX CODE IS 3105 <br />