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APPLICATW I FOR CONSTRUCT )N PERMIT , o <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT az'i� Tr <br />BUILDING DEPARTMENT HEATING SYSTEM: q GAS �d ELECTRIC 11 hTe l Lv .k <br />259-8810 <br />I DEMOLITION 17 COMBINATION )KBUILDING CI MECHANICAL LI PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS <br />JA1 s T. <br />CITY <br />Q. A_1_ <br />ZIP PNONE <br />lwJk �roa <br />s3 vrnc <br />tEN%NT <br />MAIL ADDRESS <br />CITY <br />21P PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />(Zol j 35 3 - (dy S <br />FSST <br />GENERAL <br />C��s�r70-^ij <br />' SE <br />1=.,A c�\ WtiSI, <br />o <br />Sar s MSScoK�Fo5s8oP <br />CONTRACTOR <br />MAILADDRESS <br />CRY <br />ZIP PHONE <br />STATE LICENSEE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSEE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE/ <br />CONTRACT PRIG OF WORK <br />DESCRIBE WORK AND 90UARE FOOTAGE INVOLVED <br />LD ,;T PERSON AND PHONE NO. <br />u1kc,V 2 X <br />c� <br />Srtop <br />c,rr"��—` L��lu`"�'�u <br />PROPOSED USE OF BUILDING $ Mp p <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />'ommot <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESDRIPTIGN OF PROPERTY (SHOWN BELOW 04 ATTACH TWO COPIES) <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />R <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />r rccl A L4 V Z- 51`k-wn III ICy ny!LA; <br />2E Aj <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />!!11 <br />P I 6 <br />OWNER OF THIS PROPERTY TO PERFORM THE <br />In ler <br />WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TAX I D. NUMBER <br />Lob A)E . <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />CONSTRUCTIGN LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />�o (1'r— <br />PROJECT ADDRESS <br />5� e a ^� S S E fare 1� LJa <br />Sa <br />nnHM� <br />A% 1Cr <br />to 3 <br />o BUSPR"LICENSE N0 <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;C—AIHNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />I <br />LAVATORY (WASH BASIN) <br />, <br />UNIT HEATERS—B.T.U. M <br />' <br />SHOWER <br />' <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK & OISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDgYTRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />, <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />T— <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />, <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />—T- <br />SUB TOTAL E <br />SUB TOTAL E <br />PERMIT E <br />I <br />PERMIT E <br />TOTAL FEE $1 <br />TOTAL FEE E <br />FOR OFFICE USE ONLY: n.) A__ <br />FRONT 6ET811CK <br />REAR 6E )BJAICODBASEMENT <br />SETBACK <br />FEE /J7 _ J <br />RE(E,IQT NO <br />zo <br />USE ZONE <br />LOT AREA <br />SITE <br />FEES <br />VALUATION <br />FEE <br />`7 <br />ES ❑ NO <br />ffBUILDING <br />IYPEdLONSi. <br />NO.OFSTOY <br />KEdawrunNurnslrmqj <br />SIZE OF BLDG <br />FIRE SPRINK <br />$ <br />ES f✓NO <br />' <br />OCCUPANCY LOAD <br />FIRE Z& EO'D <br />HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />A <br />NA <br />-- AW L <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />, <br />CITY OF EVERETT <br />INTAKE BY <br />PLANS APpTAVED By <br />pUBLICWORKS <br />— <br />J <br />LOCAL SALES <br />TOTAL <br />DATF i3 <br />TAX CODE IS 3105 <br />