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APPLICATIG.i FOR CONSTRUCTm*3N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 04rr <br />HEATING SYSTEM U GAS )] ELECTRIC U <br />BUILDING DEPARTMENT - �1 <br />259-8810 <br />1 1 DEMOLITION (COMBINATION 14 BUILDING MECHANICAL XPLUMBING SIGN <br />,coo L"Y ZIP PHONE I-,..rE- <br />ZL}21 Y•1 AC PI- S c- (.1UC 12�Tv cl B7.o3 347423 I 16'4 <br />,cn I <br />N.n'L nuuncaa <br />CRY <br />71P <br />PHONE <br />ARCHITECT OR DESIGNER <br />G RAL CONTRACTOR <br />MAIL ADDRESS <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CITY ZIP PHONE <br />STATE LICENSE 4 <br />` 7 <br />�/L-e17� <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESC <br />_ <br />CITY ZIP PHONE <br />STATE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRc'S <br />CITY 71P PHONE <br />STATE LICENSER <br />CLASS OF WORK <br />NEW x ADDITION <br />ALTERATION <br />REPAIR DEMOLITION WOODSTOVE/FRPL INSERT <br />RUILDIUIG RFI nCATInN <br />/) <br />CONTRACT PRICE OF WORK ,VL <br />Cfgj1{TArT PERSON AND NONE NO <br />CA <br />cir- N\a�- <br />DESCRIBE WORN AND SQUARE F TAGE IN OLiCp <br />Ad D r bwN JTF ~v 4 [� i <br />18 4 S S <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAW, AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPI ETED 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 />CopqRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X �i <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELO'N OR ATTACH FOUR COPIES) <br />LOT BLOCK of VLJ '��- <br />PROJS1CT ADDRESS <br />SK.NAT1➢IF VAIF <br />OTY BUSINESS HCENST 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 />AC-AHNDLG UNITS-H. P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />,rl <br />UNIT HEATERS-R.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />DRIIJKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAIN --RAINLEADERS <br />EXHAI IST FAN <br />SINK (SERVICE -BAR. ETC.) <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />_ <br />PERMIT <br />$ <br />—>— <br />PERMIT $ <br />_ <br />TOTAL FEE <br />$ <br />/ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK �j,W <br />-4 , <br />REAR SETBACK <br />7-0 <br />SIDE SETBACK <br />5LrFo' 2�� <br />PLAN CHECK NUMBER <br />.�1o7 <br />FEE <br />'%z9.a0 <br />RECEIPT NO <br />&3/-`�;�)- <br />USE ZONE <br />LOT AREA -( <br />6004-¢ <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TYPE OF CONTS AUDWABLE <br />TYPE Dr CONST ACTUAI <br />PccuMwcY <br />cwm° <br />Iw aLmulwc owns <br />SIZE OF BLDG <br />IUB Sf DN <br />NO OF STORIES <br />I <br />BASEMENT <br />AICI <br />MECHANICAL <br />3V <br />ADDITIONAL PLAN CHECK <br />; <br />OCCUPANCYLOAD <br />I <br />FIRE SPRNKLERS RED <br />HEIGHT UIBTATION <br />F <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />— <br />—� <br />INTAKE BI <br />PIANS APPROVED BY <br />Jfr ` <br />^AI`IA� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />��j� <br />