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APPLICATIO. . FOR CONSTRUCTk �N PERMIT <br /> TO BE COMPLETED IF: BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS ELECTRIC V <br /> --- - --- <br /> 2598810 `/ <br /> DEMOLITION COMBINATION -vBUILDING MECHANICAL PLUMBING_ SIGN <br /> W <br /> CF MAIL ADDRESS Inr ZIP PHONE <br /> ,101'1,�►"5 -►�� E —3 r, CAM-# IF.U3 353-7377 -- <br /> TE IMA T MAIL ADDRESS CITY IIP PHONE <br /> ARCHITECTOR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> Se/�' <br /> GENERAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE STATE LICENSE <br /> S¢j <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAR ADDRESS CITY ZIP PHONE STATE LICENSE IF <br /> CUSS OF WORK <br /> NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br /> py CONTACT PERSON AND PHONE NO. <br /> CONTRAL'PRICE OF WORK /' QS D%J <br /> DESCRIBE WUR1J AND SOOUAPE FOOTp E INVOLVED �/ <br /> Udd 061 , ' r/ re VrE F 61171 oLR f <br /> PROPOSED USE OF BUILDING I v IF I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGA(DESCRIPTIONOF PROPER (SHOWN BELOW OR ATTACH FWRCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> Loi BLOCK OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> (,� ('(' j L A1C L D-DI OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ?X Ff 4S5 W j4` OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS W 18.27 RCW AND 296.200 WAC. <br /> e <br /> (Aacf*39'37-ooa- oaj-oloa _ X_�� f <br /> PROJECT ADDRESS �� E, Q(}�� 54NATUAE OAR <br /> 315.74-F- F, - &Lk (Q JQ� CRYPUSMF59Lrf NSU 041) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) ' A/C—AIHNDLG UNITS—H.P. I <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I - UNIT HEATERS—B.T(I. M i <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK44ISQ i VENTILATION FAN ' <br /> DISHWASHER '- RANGE HOOD ' <br /> LAUNDRY TRAY I WATER HEATER ' <br /> CLOTHES WASHER I WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP ' <br /> BACKFLOW PREVENTERS i GAS PIPING ' <br /> ROOF_DRAINS—RAINLEADERS I EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) <br /> � I <br /> I <br /> I ' <br /> I ' <br /> I ' <br /> _ SUB TOTALS SUB TOTAL $ S� '— <br /> PERMIT $ PERMIT $ _ <br /> _ TOTALFEE $ 1 TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBK SIDE SET PLAN CHECK NUMBER III: RECEIPT NO <br /> AC <br /> /317's-T <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEET <br /> BUILDING <br /> TYPE OF CONTS ALLOWABLE TYPE Of CONST ACTDAL Pttuwxcr MP domunc uNnE L I <br /> PLUMBING I d <br /> SIZE OF BLDG NO.OF STORIES BASEMENT MECHANICAL <br /> q29 Sf Aooa 2 <br /> OCCUPANCY LOAD FIRE SPRNKLERS REO'0 HEKLHT LIMITATION ADDITIONAL PUN CHECK <br /> I <br /> hl O SPRINKLER <br /> REASON OPSPRINKLEPS <br /> STATE BUILDING SURCHARGE y i� <br /> I <br /> INTAKBV� PLANSAPPROVEDBV CITY OF EVERETT PUBLIC WORKS <br /> JN LOCAL SALES <br /> Z TAX CODE IS 3105 TOTAL S ;S2 <br />