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APPLICATIC ! FOR CONSTRUCT' IN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS U ELECTRIC Ll <br />259-8810 <br />LI DEMOLITION I I COMBINATION I I BUILDING )(MECHANICAL I IPLUMBING I SIGN <br />OWNER MA aDDREsstfi CITY ZIP PHONE <br />6~(A) A21AY `113 84_ SJ f eF(/&9c?T `IXIOe 3JJr- 91Y7 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STALE LICENSE <br />MECHANICAL CONTRACTOR MML ADDRESS CITY ZIP PHONE STATE LICENSE <br />&UPPA corm, 9 L- 197L� �3rLy GYNyv000 `fy36 _7 U' cy�— c��aycri/ornAu <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEI <br />ycONI RACi PRICE OF WORN <br />jaO. �� <br />DESCRIBE WORK AND SOUACE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />Ft/ ,�4& f- <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 />Z 7. 4 y' <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT BLOCK — OF <br />—' <br />— <br />PARCEL TAXI D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS c <br />eyC Sl <br />s""""'' D"Tr <br />— <br />on rus:Mss url N4f rm <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—AIHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />2 <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL $ <br />SUB TOTAL _ $ <br />3 <br />PERMIT $ <br />_ <br />PERMIT $ <br />5 <br />TOTAL FEE $ <br />_ <br />TOTAL FEE $ <br />CnD ncClPc "CC nAEE V. <br />FRONT SETBACK <br />REARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FI( <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SHE <br />[ 1 YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />TYPE Of CONST <br />NO OF STORIES <br />MCI~, <br />c"01P <br />NO apVE1 L141AITS <br />SIZE OF SLOG <br />FIRE SPRINKLERS RE.DD <br />BASEMENT <br />FJ YES Fl NO <br />MECHANICAL <br />— <br />ADDITIONAL PLAN CHECK <br />— <br />OCCUPANCY LL4? <br />FIRE ALARM REG0 <br />HEIGHT LIMITATION <br />OTHER <br />I <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />PLANS APPROVED BY <br />PLANS <br />DATE <br />CITY OF EVERETT <br />SALES <br />31 <br />TAX CODE IS 3105 <br />TOTAL <br />