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APPLICATIG_J FOR CONSTRUCITAJN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC U <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />G Ets�e� kfJ��Y a4al �If PI -SE, Fuc a `r8a�3 34-?w L31 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />A16HUtDl uH ULOIUNtH <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE IF <br />_- <br />MFCHANICALCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />OF WORK <br />vCLAS-S� <br />/'NEW ADDITION <br />ALTERATION <br />REPAIR DEMOLITION <br />WOODSTOVE/FRPL INSERT <br />BUILDING RELOCATION <br />\CONTRACT PRICE OF WOR 3� <br />C <br />TACT PFR N AND PHONE NO <br />� 11 <br />V 11 ?6 Q� <br />DESCRIBE WORK AND SODA E FOOTAGE INVOLVED <br />L6�D.3 wok, <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 />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 WAG <br />x ice" <br />_Sf��- <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT_ BLOCK OF <br />_ <br />PROIFjd ^ADORE S^S l^ <br />a�/AALL C tltlo / <br />f-'e/E: <br />SImIAnU1L a.rt <br />I CITY RIAINESSLICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATFR CLOSET (TOILET) <br />A,C—AiHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS--B.TU. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —BTU. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />S� _ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />I7.1:r 9A191:211-941011!IWA <br />FRONT SETBACK <br />NA, SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />F'LI <br />RECEIPT NO <br />7s <br />USEZONE <br />_ <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />— <br />TYPE OF CONTS ALLOWABLE <br />TYPE OF CORSI ACTUAL <br />(KmwBrr <br />Wa TAYRLWB UIns <br />GIRL <br />I <br />PLUMBING <br />SIZE OF BLDG <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNYLERS RED HEIGHT LIMITATION <br />SPRINKLER <br />_ <br />REASON FOR SPRINKLERS <br />-- <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />