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APPLICATIC" FOR CONSTRUCTF IN PERMIT - <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT [ HEATING SYSTEM J GAS U ELECTRIC ❑ _- <br />259-8810 <br />DEMOLITION i COMBINATION �jC BUILDING ]MECHANICAL CI PLUMBING SIGN <br />0 ER <br />pv <br />Vf,�-L7 INTim. <br />IT <br />1451s No(+M cltcq�C WADI <br />ZIP PHONE <br />343-7140 <br />eA. <br />4o kau. ICF3M E9TAIL=«aJt' <br />rW 214 <br />6u F <br />Wll . iboll <br />TENANT MAIL ADDRESS <br />MED1A-'11✓CA► w;l <br />(�i15 -'JS+4 <br />CITY <br />-v: S.W. <br />ZIP PHONE <br />eyegem , wA. <br />ARCHITECT OR DESIGNER MAILADDRESS <br />T"RFrrrHo/WMWg 10140 <br />11,e.83RO <br />CITY <br />ZIP PHONE <br />VIEWOEs, k)A-. 18001 (Rob) 327•2110 <br />OENFRAL CONTRACTOR MAIL ADDRESS <br />J*il. C&,XMalRJ 6801- 146-kme,ox. <br />CITY <br />lzemob lWk <br />ZIP PHONE STATE LICENSE S <br />9bo32 Q*863-OZ41 JMScocdK1904 <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSE F <br />M-T <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSE, a <br />b.` <br />CONTRACT PRICE OF WORK <br />IZO 000 <br />_ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Alb <br />CONTACT PERSON At+D PHONE NO <br />PR.EIOMTS 140 Aealrreus c% wT CE 614MM <br />WSTAtAAMMJ aT ANEW oVFWIE O�.�, <br />_(_Y6 bz7-zIa0 <br />L I 6 <br />. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALI. <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 />PROPOSED USE OF BUILDING <br />Uw <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT- BLOCK OF <br />N.AM -�Wew %4UO OF.-VFAwW_- <br />II2Pj - I - pOy-0007 <br />PARCEL TAX 10 NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />1515- 75 7-)GR7' 5•W- <br />sK:.M Re %/" DATE <br />_ -- <br />11TI"NE69LKENM NO <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 />BATHTUB <br />' <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 />C'_OTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />VENTILATION FAN <br />i <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />i <br />WATER HEATER <br />' <br />_ <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR, ETC.) <br />— <br />I <br />1 <br />I <br />1 <br />I <br />1 ' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />CnO nCCH"IM I ICC nNNI V- <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />Y <br />PLAN CHEC UMBER <br />FEE U�/ <br />�1Ga. <br />RECEIPT NO <br />aF <br />,� <br />saw <br />s- <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />!L <br />LD i1('LI) <br />— <br />O YES NO <br />TYPE IA C/O�N�S�T <br />NO OF STORIES <br />TIMP9 .Y <br />N U MUMAIIII <br />L <br />Alv hgAA, 7V <br />onouF <br />PLUMBING <br />' <br />SIZE OF BLDG. <br />E SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />' <br />❑ YES i i NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ARM REOD <br />HEIGHTjLIMITAyON <br />1 <br />1 <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />i ) <br />INTAKE BY <br />PLANS APPROVED BY <br />I CITY OF EVERETT <br />PUBLIC WORKS <br />,N1 <br />LOCAL SALES <br />DATE $ /9 <br />TAX CODE IS 3105 <br />TOTAL <br />