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APPLICATIO.: FOR CONSTRUCTI N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEA�E PRINT 00:7T <br />BUILDING DEPARTMENT I HEATING SYSTEM: J GAS U.&LECTRIC J <br />259-8810 <br />JX DEMOLITION COMBINATION 1 1 BUILDING MECHANICAL I PLUMBING SIGN <br />OWNER NAIL ADDRESS CITY ZIP PHONE <br />Wl ltd Nu j_ GOA,,Ar FIt_��0? <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />JJl1`+4-k.5 t)AAit IA,L If. It Y'l)444,. _« A.-fllelL vfi_wmv i/lirtr• �.o.,r <br />CITY ZIP <br />PLUMBING CONTRACTOR MAIL ADDRESS C 'Y ZIP PHONE STATE LICENSE 1 <br />CONTRACT PRICE OF WORK <br />DESCRIBE WC& AND S 1 F T E INVOLVED <br />CONTACT PERSON AND PHONE NO. <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 JE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONSAUTHORITY TO VIOLATE OR CANCEL THE NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <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 />CONTFj�CTpRS LAW 18.27 RCW AND 296.200 WAC, <br />- /y- iPROJECT <br />JAI.' <br />PROPOSED USE OF BUILDING <br />LEGAL DEScC PTKIN OF PROPERTY ISHOWN BELOW OR ATTACH TWO COPIES) <br />Lor QG BLOCK 1 of <br />5 1 J y ^ ` 7 0 T 7j <br />PARCEL TAXI D NUMBER <br />CONS RUCTION LOAN LENDER.ADDRE <br />123 !7; - SS. TELEPHONE NUMBER <br />jPe-, <br />ADDRESS <br />BATE <br />TIT'RUSiNI SS I n II N51 W <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 />WC—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />1 <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />1 <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />1 <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT $ <br />_ <br />_ PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />PEAR SETBACK <br />SIDE SETBACK <br />PLAN CH§CKNUMBER <br />III <br />RECEIPT NO <br />�a a <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />F1 YES `-i NO <br />BOILDING <br />- <br />- <br />TYPE M CORST <br />NO OF STORIES <br />axuA1N[T <br />W RI VMRIM 111.'T6 <br />°Ap'R <br />PI UMBING <br />MECHANICAL <br />�— <br />SIZE OFBLDG <br />FIRE SPRINKLERS PEOD <br />BASEMENT <br />YES fl NO <br />— <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HE IC.HT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />RAh6APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />7014L <br />