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✓.&T I1 <br />----- APPLICATIC-1 FOR CONSTRUCT' IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT T <br />BUILDING DEPARTMENT HEATING SYSTEM: 29 GAS 0 ELECTRIC a <br />259.8610 <br />! 1 DEMOLITION <br />_I COMBINATION A BUILDING I I MECHANICAL I IIPLUMBIINGGCI SIGN <br />OMER <br />MAIL N ZIP E TRR�I lNTeks �o5gi ^I.clS�Wwi?-Gy807Z /,W 881-008? <br />TENANT MAIL ADDRESS C" ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />q— I /I ns"l+a94S 70.1 /9fNS.E:. 4UtQtg 98t.og (,g!�eQl Ny _ &569 <br />GENERAL TRACTOR MAIL ADDRESS _ _ CITY ZIP PHONE STATE LICENSE t <br />MECHANICAL CONTRACTOR MAIL ADDRESS Sf CITY ZIP PHONE STATE LICENSE <br />W40Ri�onl }%mina 3601 /21 lsw. Lynwood 98039 7yS"-A30 <br />PIUMBWO TRACTOR ADDRESS C❑ ZIP PHONE STATE LICI NSF.6 <br />CONT,IACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PNONF NO <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 2 6.200 WAG. <br />(� p <br />O �%%`,�_ <br />PROPOSED USE OF BUILDING / r <br />-,7 E rml <br />LEGAL bESCRITMON OF PROPERTY (SWIM BELOW OR ATTACH TWO COPIES) <br />P 39C� <br />LOT FROCKof S <br />J/ Li <br />PARCEL TAX 10 NUMBER <br />CONSTR TIONJOAN NDEy. ADDRESS. TELEPHONE NUMBER <br />e0ALd*n T 1 MdlLfq"!e _ ?ASS=f�88 <br />PROW <br />PROJE� ADORE cSf ..S (/ ) <br />R'OHR RArf — — <br />f:I,YRlANFssi,CLH;, Wl <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 />A'C-AHHNDLG UNITS-H.P. <br />H <br />/ <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />i <br />/ <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP - <br />---------- <br />_- <br />VENTILATION FAN <br />i <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />i <br />L <br />WATER HEATER <br />/ <br />CLOTHES WASHER <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />' <br />HEAT PUMP <br />' <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />H <br />_ <br />SINK (SERVICE -BAR, ETC.) <br />, <br />, <br />SUB TOTAL $ <br />'1j' <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />-~ <br />TOTAL FEE $ <br />enFn /At GIARG I ICU AMI V. <br />FRONT SETBACK <br />" <br />REAR SETBACK <br />SIDE SETBACK <br />A <br />PLAN CHECK NUMBER <br />/ <br />FEE ✓ <br />RFCEIPi NO <br />`Ir <br />z0 <br />Zp <br />s <br />2-3 <br />J 3 <br />USE <br />� <br />LOT AREA <br />VACANT SITE � <br />FEES <br />VALUATION <br />FEE <br />-7� <br />� <br />o <br />❑ YES yi NO <br />BUILDING <br />TYPE BE CANST <br />NO OF STORIES <br />OCCIINACY <br />,O M MLOWA I'S <br />. / <br />/ <br />PLUMBING <br />i <br />SIZE OF BLLDGG <br />A%y% <br />FIRE SPRIffLERS REOD <br />BASEMENT <br />MECHANICAL <br />O�] ' <br />ADDITIONAL PLAN CHECK <br />j3 :- t <br />Iva <br />❑ YES 7 NO <br />OCCUPANCY LOAD <br />FIRE ALAR PEGD <br />HEgHT LHMITATId/ <br />-, <br />OTHER <br />REASON <br />- <br />STATE BUILDING SURCHARGE <br />- <br />' <br />INTAKE BY <br />PLANT A 10 EO BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />1d�8� 3 <br />LOCAL SALES <br />DATE _j o <br />TAX CODE IS 3105 <br />TOTAL <br />mo <br />