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APPLICATIO.. FOR CONSTRUCTL A PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT rT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J - <br />259-8810 <br />DEMOLITION <br />f_l COMBINATION <br />❑ BUILDING <br />❑ MECHANICAL i ) PLUMBING Fi SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PRONE <br />All` FRANK RASEKA <br />21O\ 73'-P Sr. <br />F_UEAzeTT <br />98203 <br />TENANT <br />M4L ADDRESS <br />CITY <br />ZIP PHONE <br />S hn _ AS <br />h 13m1E <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />14 <br />4 <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />BR71�iEWAY CdJSTR� cvJ 382Fi alWD(AufAl t?AkK ALA. N. S64TYLE 98ro3 (arrv�b3Zo8co �RICIEI[GIC�fnR3 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE F <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE / <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOVARE FOOTAGE INVOLVED ,r <br />Q <br />C <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 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 18.27 RCW AND 296.200 WAC. <br />pI '(JJJp <br />X (C)aghs Q . __.._ ��` J / <br />RwNAr L -VAAIIr <br />I'll ROSiNI'S5 I IN 161 rm <br />PROPOSED USE OF BUILDING <br />1 <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH TWO COPIESI <br />UOr BLOCK OF - — <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBERI' <br />PROJECT ADDRESS <br />� R� <br />' 'Z ST. 62,D <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTJRE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS-H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />_ <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR, ETC.) <br />' <br />I <br />I <br />I <br />I <br />, <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />' <br />PERMIT <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />I E <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />a YES 11 NO <br />BUILDING <br />TYPE OF COAST <br />NO OF STORIES <br />O NWA <br />WINIHAUWOMITI <br />ORMP <br />PLUMBING <br />' <br />I <br />SIZE OF BLDG <br />FIRE SPRINKLERS REO'O <br />BASEMENT <br />MECHANICALI <br />❑ YES 13 NO <br />ADDITIONAL PLAN CHECK <br />, <br />OCCUPANCY LOAD <br />FIRE ALARM REDD <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />