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C H <br />c <br />APPLICATIGA FOR CONSTRUCT.JN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT LI II.AT ING SYSTEM: ,d GAS ❑ ELECTRIC J _Sa,E _iMT01 <br />259.8810 <br />DEMOLITION COMBINATION BUILDINGi Fes.. MECHANICAL PLUMBING SIGN <br />OWNER MAR ADDRESS CITY SIP PHONE <br />5O l R,,f Ora' 3s <br />TENANT MAILADDRESS CITY TIP PHONE <br />4-> L1 / I.F.. /l,40 , Z. E h 1 T7, IC..•=7-t- �- <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />W.1 <br />c,. <br />.— <br />S M <br />1LLFix <br />100 W w"VA <br />el4tA, iz <br />GENERALCONTRACTOR <br />MAIL ADDRESS <br />CRY <br />SIP <br />PNON <br />�z6.487y <br />STATE LICENSE E <br />-i" M � CDNSTF�r <br />• <br />(S Se, lrlay��1 <br />wA� <br />'�'�zs c�Jrtia <br />48oss <br />•�R1FcoT= 1�18tN0 <br />MECHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />STATE LIC NSE <br />PLUMBNGCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CLASS OF WORK <br />At TCRATInN RFPAIR <br />DEMOLITION <br />WOODSTOVE/FRPL INSERT <br />BUILDING RELOCATION <br />.---- -- <br />CONTACT PERSON ANDPHONE NO <br />CONTRACT PRICE OF WORNwo <br />DESCRIBE WORK AND SQUARE FOOTAOC INVOLVE <br />/ <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />,• I <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FWRC01`IESI <br />LOT BLOCK OF <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 />CONTRA T RS LAW 18.27 RCW AND 296.200 WAC. <br />soHArlmE WE <br />�. M_ F • C�Si, ,A1G <br />PR0.1ECi ADDRE69 i <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 />BATHTUB <br />AIC—A. HNDLG UNITS—H P <br />_ <br />FORCED AIR SYSTEMS—B I u M E.A. <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />I <br />CLOTHES DRYERS <br />SHOWER <br />' <br />_ <br />KITCHEN SINK 6 DISP <br />_ <br />' <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />_ <br />; <br />CLOTHES WASHER <br />r <br />WOOD STOVE <br />UHINAL <br />' <br />METAL FIREPLACE & C NEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT/i <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />13ACKFLOW PRE NTERS <br />; <br />GAS PIPING <br />ROOF DRAINS,41RAINLEADERS <br />EXHAUS AN <br />SINK (SERV E—BAR, ETC.) <br />I <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE E <br />,FOR OFFICE USE ONLY: <br />FRONT SETBACK Hl All r.1 'PA, .. SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO <br />USE ZONE <br />M' <br />LOT AREA <br />VACANT SITE <br />No <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' J 1♦'1 <br />TYPE OF71S AI LOWABLE <br />/_ <br />TYPE OF COAST ACTUAL <br />IKIIAYACE <br />13-"', <br />Ao nvxnnw. rA.rs <br />� <br />PLUMBING <br />K <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />T <br />OCCUPANCYLOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />' <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANE <br />/A111 <br />APPROVEDBY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />rIIRIIclAORKS <br />TOTAI <br />N <br />T! <br />