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APPLICATIOkv FOR CONSTRUCTI.JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC U ILNtt r _, l <br />� — J <br />259.8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />031 <br />Efl C MAIL ADDRESS CITY IF 1 I ZIP U , PHONE <br />TENANT G� M L ADDR 59 a I S} S C�ITY F— e a tf CIzip 3 Zs'1� PHONE <br />ARGHITEGT OR DESICNEX <br />MAa wuncJJ <br />GIIY <br />❑Y rrnmc <br />S,�Nb Drr,�rl.l[��rn <br />fo11� !a„r'PI <br />DK. <br />�, <br />KEA <br />�iRZO1 259-1311 <br />GoHnC*4-110. <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />CLASS OF WORK <br />X NEW ADDITION <br />ALTERATION <br />REPAIR <br />DEMOLITION WOODSTOVE/FRPL INSERT <br />BUILDING RELOCATION <br />// M ' -,'- <br />—p n..♦ <br />CONTAjy`i P RSCN AND PHON <br />-0 <br />Q <br />CONTRACT VRK;E OF WORK ,9�2 I e, ^'1" <br />E NO. <br />G I �)(_1 S-l- I-6I I <br />DESCRIBE WORK AND SUARE FOOTAGE INVOLVED <br />Cclic <br />f3 - aGYG <br />PROPOSED USE OF BUILDING <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 />WOOK 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 1 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 />LEGAL DESCRIPT OF PROPERTY ISHOWN BELOW OR ATTACH FUR COPIESI <br />LOT BLOCK OF <br />J� p 1 <br />/fit i C,QN uQj A�COQ.�IY1C -IO TI'LC 7 �lii <br />1l "� F�' <br />1 `1�L♦TJ�I- D..L,,-,J _d La 1/a1L '� <br />y - <br />DrgGD(Dws 4 .]L/d��� <br />�I/I���r��� <br />Pm CT ESS <br />c;,— 7-t�r.T ,re) <br />av H wR <br />,.ryo5'HI Ss 111 FNSt Hn -- <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 (TOILE]) <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK d DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER z <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE d CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVth TERS <br />GAS PIPING <br />ROOF DRAI RAINLEADERS <br />EXHAUST FAN <br />�— <br />SINK (SE ICE -BAR. ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT S <br />I <br />PERMIT E <br />) <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />FOR OFFICE LISP ONLY: <br />FRONT SETBACK <br />7-010 <br />REAR SETBACK <br />5 <br />SIDE SETBACK <br />A <br />PLAN CHECK NUMBER <br />91 a 7 9 9 0 <br />FEE <br />74' o c' <br />RECEIPT NO <br />S 77a <br />USE <br />LOTAREA <br />N aco <br />VACANT SITE <br />t3D <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE Of CONTS. ALLOWABLE <br />TYPE Of CONS] ACTUAL <br />AJ <br />muwAC. <br />No a ownli �p,IL <br />SIZE OF SLOG <br />NO OF STORIES <br />BASEMENT !Y <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY CAD FIRE SPRNKLERS REGO HEIGHT LIMI�TION <br />AO AP 15 <br />REASON FOR SPRINKLERS <br />INTAKE BY PLANS APPROVED BY CITY OF EVERETT <br />LOCAL SALES <br />SALES <br />�✓ 9'�1 TAX CODE IS 3105 <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />/ '♦~ <br />PUBLIC WORKS <br />TOTAL <br />/ J <br />J <br />