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FA <br />APPLICATIf 1 FOR CONSTRUCT ')N PERMIT Oj;�. <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS I] ELECTRIC U__ J <br />259-8810 <br />1 DEM_OLITICI , 11 <br />COMBINATION CI BUILDING 1 MECHANICAL I ; PLUMBING SIGN <br />c ICI r iJa Rn4 MAI/AD.J Q - CITY ZIP <br />InzIPP.?�Y� PHON�.SS—/O <br />ILNANT MAIL ADDRESS CITY ZIP PHONE_ <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />[ qR ICMARl1S <br />-TAME <br />AS .4&'IF__ <br />NERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE F <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZII' <br />PHONE <br />STATE LICENSE I <br />CONTRA RICE OF RK <br />y&v <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />i 'X 30' (RrPRoX yao MP ' r <br />0 d- s <br />OF /10ME <br />C <br />CONTACT PENSON AN:. PHONE NO- ) C ^ p 5 — I <br />�Y a/LC+!/ <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS CF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMFIT ETED 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 18.27 RCW AND 296.200 WAC. <br />,%� <br />x_ 9 -a3-Y3 <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />RI <br />LOT 1-3 BLOCK Qp D-00 h/lr 1ND 1//Fl!/ <br />9ARCEL TAN 1 D NUMBER <br />" -M1�-D13-yov3 <br />_y7�3 <br />CONSTROCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />-,a 3 <br />BMNAmAE - DATE <br />11TVAO111<C1 ,4:I <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 />I <br />A/C—A/HNDLG UNITS—H.P. <br />1 <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />T <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />I WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />I <br />, <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />F34 . lId3Ti7-1F-i3417k,IA'A <br />FRONT SETBACK <br />I <br />REAR SETBACK <br />1 <br />SIDE SETBACK <br />1 <br />PLAN CHE K NUMBER <br />11ao1� <br />FEE <br />�a.�5 <br />RECEIPT NO <br />aq a <br />: <br />2J <br />I r <br />usE oNE <br />zf <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />�— <br />I <br />I-' YES 0 NO <br />ITPF OE CONS) <br />NO OF STORIES <br />o[EuvMAr <br />wElfwWWAIN <br />�_ <br />R0Vv3 <br />f <br />PLUMBING <br />SIZE OF BLDG <br />FIRE SPRINKLERS PEO'D <br />BASEMpor <br />MECHANICAL <br />1 <br />NO <br />ES ❑ NO <br />ADDITIONAL PLAN CHECK <br />C UPMCY LOAD <br />FIgE ALARM RFOD <br />HEI�HTLIMITATKW <br />N <br />dwx IN <br />OTHER <br />� <br />REASON <br />STATE BUILDING SURCHARGE <br />i ) <br />INTAKE BY <br />PLANSAPeRQVEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />�+— <br />, <br />--� <br />J 'qy <br />LOCAL SALES <br />TOTAL <br />5;� <br />DATE �Z 43 <br />TAX CODE IS 3175 <br />