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APPLICATIC 'I FOR CONSTRUCT -IN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT xrr <br />9 <br />BUILDING DEPARTMENT <br />259-8810 <br />HEATING SYSTEM: U GAS ' <br />ELECTRIC U <br />❑ DEMOLITION <br />I 1 COMBINATION <br />I 1 BUILDING <br />I MECHANICAL <br />I I PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />Y►11cHAe1. 5. zUItPISoN <br />5I5 -mixt <br />sr, 54' . <br />EvOJLTf _192•o3 <br />;o6-3S3-61/So <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />"NG2 <br />- <br />ARCHITECT ORDESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />M Z. Cv1z�i CAA94L <br />(CWM t� <br />snene_ <br />1• <br />rns,zWry ossBop <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />STATE LICENSE F <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE F <br />CONTRACT PRICE OF/ ORK �— <br />DESCRIBE WORK AND SOUA . FOOT E ILIV' V D F <br />C NJAC <br />PER <br />AND PNOr�E <br />DIt< (1 V4.T I <br />r1'���c�ec:Q �-- TO rnt9'� BLSEsK• <br />t'Y7LtS[' <br />' ' 3 � <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 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 />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 1827 RCW AND 296.200 WAC. <br />� J✓�1L1� ir�3o�R 3 <br />_ <br />PROPOSED USE OF BUILDING <br />JA <br />LEGAL DESCRIPTION ROPERTY IS BELOW OR ATTACH TWO COPI <br />aji G -- <br />LOT BLOCK of <br />PARCEL TAXI D. NUMBER <br />672d%�S-Z- �Z <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />YuoiL__ <br />PROJECT ADDRESS <br />'ZF.I;C,2ffti7-01 <br />BnN++uKF G1Z7(oi wrE -. <br />CITY MISNESS ICENSLw <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-AJHNDLG UNITS-H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />/ <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />{ <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />I <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />_ <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />' <br />SINK (SERVICE <br />I <br />' <br />I <br />' <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT E <br />TOTAL FEE <br />TOTAL FEE $ <br />eno neelec T 1¢F nut V. <br />FRONT SETBACK <br />ZONELOT <br />REAR SETBACK <br />AREA <br />610E SETSA J <br />VACANT SITE <br />PLAN CNEC NUMBER <br />FEES <br />NOUSE <br />FEE <br />U I <br />PLUMBING <br />*FEERECEIPT <br />o ' <br />� I <br />Cl YES ❑ NOBUILDING <br />TYPE Of CONST. <br />NO OF STORIES <br />aca y <br />'1 <br />IR a virtu a An <br />SIZE OF BLDG. qW sf <br />S <br />FIRE SPRINKLERS REGO <br />BASEMENT <br />❑YES [T�J0 <br />MECHANICAL <br />I <br />ADDITIONAL PLAN CHECK <br />�'/'I���`` rJ <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />p <br />HEIGHT LIMITATION <br />ZI <br />OTHER <br />' <br />I <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBUC WORKS <br />INTAKE By PLANS APVRQTD BY CITY OF EVERETT <br />J I LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />�7 �;j <br />