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APPLICAT10I1 FOR CONSTRUCTON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT T V <br /> , F HEATING SYSTEM: GAS U ELECTRIC Li <br /> 259-8810 <br /> _ DEMOLITION COMBINATION (/BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAIL ADDRESS CITY ZIP PHONE1�� <br /> (-fir ee4ofm � Io�Zo NE P 1 a err ip -i �„ -� 1��� . �p�lUc/ <br /> TENA MAIL ADDRESS CI ZIP PHONE <br /> jjmA <br /> AYa'cL crr .SE U2 Ed d.: L.�A 9,p Q0 ( <br /> ARCHITECT OR DESIGN R MAIL ADORE S CITY ZIP • PHON <br /> RobaA S M Iltr <br /> + e-,e. ILY� ((1��1 1!, kla.d / lA 9cYo 3 3 Odt 8 2 -Uloo <br /> GENERAL CONTRACT R 1 MAIL ADDRESS CITY ZIP PHONt STATE LICENSE. <br /> l7W Nrr�Jk, GYC/' Sf/fLF✓1 �Ar� P. �,^I r. c� 15�N�...-1' <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY Z,P PHONE STATE LICENSER <br /> CLASS OF WORK <br /> NEW ADDITION '✓ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT I BUILDING RELOCATION <br /> CONTACT PERSON PHONE <br /> CONTRACT PRICE OF WORK -w-" F <br /> DESCRIBE WORK AND SOUARE FOO AG NVOLVED <br /> /oma 3 v <br /> PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Q ¢.. La �, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT BLOCK of _ 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 10.27 RCW AND 296.200 WAC. <br /> EI/r/C-(-4 '7iU CUwMMCr[/ CY�n <br /> (4/0 - 92* 5T 5w �. F x (Pir,:•i7:.Q 1-2( 91-n6 <br /> PROJECT ADDRESS .L bKSHAiURt DATE <br /> CITYBUSMFSSIICENSEw <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C-A)HNDLG UNITS-H.P I <br /> BATHTUB ' =ORCED AIR SYSTEMS_--B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) 1 UNIT HEATERS-B.T.IJ_ M 1 <br /> SHOWER ' CLOTHES DRYERS I <br /> KITCHEN SINK&DISP _ i VENTILATION FAN ' <br /> 1 <br /> _ DISHWASHER I RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER ' <br /> CLOTHES WASHER I WOOD STOVE ; <br /> URINAL ' METAL FIREPLACE d CHIMNEY ' <br /> DRINKING FOUNTAIN , FIREPLACE INSERT ; <br /> FLOOR DRAIN ' HEAT PUMP I <br /> BACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS I EXHAUSTFAN , <br /> SINK(SERVICE-BAR.ETC.) <br /> I <br /> I ; <br /> I �- <br /> I ; <br /> I , <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ --+— <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO Jj <br /> 4 c1, 3�3� Wv 9a <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> M-M' aQ BUILDING <br /> TYPE OF LONiS AVOWABLE TYPE OF CONST ACTUAL accuwxcT NO MBwtuIK1(MIA -- -J <br /> Ivi mi "0 W- � PLUMBING <br /> SIZE OF BLDG NO OF STORIEC BAS MENT �— <br /> MECHANICAL I <br /> T.IE b D — —}-- <br /> OCCUPANCY LOAD FIRE SPyRNKLERS REOD HEIGHT LIMITATIONADDITIONAL PLAN CHECK <br /> r2Z SPRINKLER <br /> REASON FOR SPRINKLERSrf`L ���ALL.. <br /> L W,I5A7 * -r1-n STATE BUILDING SURCHARGE ! ' <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL ; <br /> I <br />