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APPLICATIC I FOR CONSTRUCT' IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT evrircrT <br />HEATING SYSTEM: U GAS J LLECTRIC <br />BUILDING DEPARTMENT <br />- <br />- <br />259.8810 <br />DEMOLITION I COMBINATION <br />BUILDING <br />I I MECHANICAL I <br />. PLUMBING LI SIGN <br />OWNER y�MAIL ADDRESS <br />/1/-!'�•', <br />CITY/ <br />S%S <br />ZIP <br />�g269 <br />PHONE <br />i-i �s/it /d/b'FS`lr�s <br />�l�+r.9%� <br />a`2 <br />TENANT MAIL ADDRESS / <br />CITY <br />ZIP <br />PHONE <br />!- <br />11 <br />L NL �•r •T' a.l'SON <br />GrB VYt� <br />/9;2cl <br />�.sl <br />QJa3� <br />AniBS�(1H <br />ARCHITECTO DESIGNER /•�/ MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />DENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE F <br />MECHANICALCONTRACTOR MAIL ADDRESS <br />CITY <br />DP <br />PHONE <br />STATE LICENSED <br />PLUMBINGCONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE II <br />CONTRACT PRICE OF WORK /'/Z 3 .0 <br />DESCRISE WORK AND SOUARE FOOTAGE INVOLVED <br />C TACT ERSONANDP ENO 6e 4 7 <br />'� tLNfF� l IO <br />ct ft-r�� <br />Cc' lOr 1 �.Za Ste• T°v I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOO D USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTYISHOWNB LOW OR ATTACH TWO COPIESI <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT "Ya BLOCK of <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />U i ec.D <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />pp p - Q y2 _ L7 UO3 <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS (,Vle YC/I )�/./9 % p <br />( L (� S"QUO <br />CRY s%wAI XIf N s I NO <br />- �l T L: S .. <br />a C. l T <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />�_ <br />NC—A'HNDLG UNITS—H.P. <br />' <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />' <br />UNIT HEATERS—B.T.U. M <br />� <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />' <br />' <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />- <br />' <br />METAL FIREPLACE (WOOD BURNING)URINAL <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />, <br />I <br />' <br />I <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />' <br />TOTAL FEE $ <br />TOTALFEE $ <br />' <br />FOR OFFICE USE <br />FRONT�ETBACI,_ <br />5m� <br />vAnEA <br />USE ZONE <br />LOT <br />TYPE OF CDNSi <br />NO OF STORIES <br />SI- J <br />BI W 110e. GAS <br />FIRE SPRINKLERS REOD <br />REASON <br />INTAKE BY <br />DATE <br />BY <br />PLAN CHECK UMBER FE RECEIPT NO <br />HECK g/ yb <br />❑ YES -1 NO <br />BUILDING <br />-- <br />PLUMBING <br />acwAA[r <br />6R01' <br />.I <br />Ao aoN[Hnm lmns <br />� <br />MECHANICAL <br />BASEMENT <br />n YES r40 <br />ADDITIONAL PLAN CHECK <br />HEIGHT LIIIZ;ION <br />Z ( / <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />j TOTAL <br />a <br />