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LJU WAmRiMATlf ti FOR CONSTRUCT"7N PERMIT <br />�JIJ DEC 16 1994 TO BE COMPLETED IN BLACK INK —PLEASE PRINT 04:77 <br />- <br />BUIMI&Y, 9EAM W 9cif HEATING SYSTEM: &&S U ELECTRIC U <br />259.BRPblic Works Dept. ! <br />L I DEMOLITION I I COMBINATION ❑ BUILDING V ECHANICAL fffLUMBING I I SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />tvuldL. kcd 30'v-j'y 5'21 9(0t'St-S'f- `E"-Let+ 987T22 355-9704 <br />AIY <br />ARCHITECT OR DESIGNER MAR ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CRY ZIP PHONE STATE LICENSEE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSEE <br />sta r A-" nf- KIrIc.lo v/ 9S�3U 8a3 44SV SuNux�*1o�j6 <br />PLUMBSKE CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE <br />' CONTRACT PRICE OF WORK <br />38-T5- <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. 41 <br />CE0vYV2I} Ihou'r sLISV1r1 4b <br />I-Not+.11 q <br />Gi/i. <br />g;j,3-k4LaSLI — <br />ILooL, s-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 />/ <br />L'ilj_k� � � v 4 1 <br />PROPOSED USE OF BUILDING <br />11R S \GLEq,1 I [4i <br />LEGAL DESCRIPRON OF PROPERTYISHOWN SELOWOR ATTACH TWO COPIES) <br />LOt BLOCK OF <br />PARCEL TAXI D NUMBER ` -01(n- 000 <br />(a4�C,U-ooL '3 <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS <br />BKIX N%In .A <br />o7- n o o DATE <br />UTY Rlmun m I.J n-, M <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />BATHTl1B <br />' <br />FORCED AIR SYSTEMS—B.LU. M^EA. <br />' <br />LAVATORY(WASH BASIN) <br />, <br />UNIT HEATERS--B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />, <br />KITCHEN.iINK 8 DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />I <br />RANGE HOOD <br />, <br />LAUNDRYTRAY <br />I <br />t <br />WATER HEATER_ <br />CLOTHESIVASHER <br />, <br />WOOD STOVE <br />, <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />DRINKING I'OUNTAIN <br />, <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAIVS-RAINLEADERS <br />I <br />EXHAUST FAN <br />, <br />SINK (SERV'CE-BAR, ETC.) <br />' <br />I <br />_ <br />' <br />I <br />i <br />I <br />SUB TOTAL <br />$ <br />i <br />SUB TOTAL S <br />U' d U <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />TIFF <br />RECEIPT NO <br />CGS (5 <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />n YES n NO <br />BUILDING <br />; <br />tYPE Of CiONST <br />NO OF STORIES <br />ORYE'MICY <br />A.aP <br />NJ aPMl1IR Unit <br />PLUMBING <br />i <br />SIZE OF SLOG <br />FIRE SPRINKLERS REDO <br />BASEMENT❑ <br />YES n NO <br />MECHANICAL <br />, <br />ADDITIONAL PLAN CHECK <br />) <br />OCCUPANCY LOAD <br />FIRE ALARM REG D <br />HEIGHT LIMITATION <br />OTHER <br />i <br />' <br />REASON <br />STATE BUILDING SURCHARGE <br />T— <br />' <br />INTAKE BY <br />I PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />) <br />LOCAL SALES <br />TOTAL <br />; <br />DATE <br />TAX CODE IS 3105 <br />