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APPLICATICA FOR CONSTRUCT-1N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: kALS J ELECTRIC J <br />259-E810 <br />IY�,IDEMOLITIONm COMBINATION EB�U�{IILLLDINGf� II MECHANICAL PLUMBING i SIGN <br />IP <br />\-\' 'h.Tl �IVy 1'[�ll }�NGNE <br />��� <br />TENANT MAIL ADDRESS CITY ZIP Y PHONE <br />ARCHITECT OR DESIGNER MAR ADDRESS � � CITY ZIP -,3 PHONE ALPR132- <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE" <br />MECHAKICk CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE" <br />PLIIMBINGCONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE E <br />CONTPACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PRONE NO ^ L D O-1 S <br />J��1 OC <br />RASIG 2Z7 <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 WAC, <br />L �a� q 3 <br />PROPOSED USE OFB Ir <br />LEGAL DESC PTKONOF PROPERTY (SHOWN BELOW oaAT,TAC14TWOcoPIE SI�X <br />��/iJ ` Syy� <br />Lar- BLOCK of /V� <br />I <br />-- <br />PATICELTAXI U N^MBER n ` D�\ - 60 3 <br />CONSTRUCTION T'IION LOANVLE✓NDDEER. ADDRESS, TELEPHONE NUMBER <br />PROJECT ADD ESS <br />saNMUIIE —� DArI <br />CITY"INESS ICI NSf W <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 />I <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />' <br />I <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />; <br />T— <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK B DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TPAY <br />( <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />' <br />I <br />T <br />SUB TOTAI. $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />_ <br />my ^kU v. <br />Fvn vI T <br />FRONT$LTBAC' <br />REAR SETBACK , <br />SIDE SSTRA;K <br />PLAN CHE KNU ER FEE 6� <br />3VALUA <br />REC iN0 <br />Gf(/(F/EE <br />USE 2 (-�^JJ((�—JJ <br />._1 <br />Lor ARE <br />VAZANT SITE <br />YES ❑ NO <br />FEES VALUATION <br />BUILDING <br />O <br />S310 : � <br />TYPE Of CONST NO OF STORIES a[UNN[r Iq d PATum"IMIIS <br />it , L " <br />BLDG I <br />512E OF flL06 FIRE SPRINKLERS PEOO BASEMENT <br />OF <br />� 3 S f- eves �o <br />L <br />OCCUPMZY LOAD FIRE ALARM REO0 HEIGHT LIMITAU N! <br />V /A[��Q {J , <br />PLUMBING <br />MECHANICAL <br />I00 <br />' Q Ci <br />ADDITIONAL PLAN CHECK <br />OTHER <br />/O <br />STATE BUILDING SURCHARGE <br />REASON =I — <br />PUBLIC WORKS <br />'po i dL <br />INTAKE BY <br />PLANS�ROyED BY <br />pJ, <br />DAff u Zl$ S3 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 31115 <br />TOTAL <br />707 ; SL <br />