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APPLICATI^N FOR CONSTRUC' 'ON PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT o;n <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS U ELECTRIC U <br />259.8810 <br />i DEMOLITION 1-1 COMBINATION ❑ BUILDING <br />I SIGN <br />OWNER MAIL ADDRESS CITY 21P PHONE <br />oaf, 1f1 �o S•��tiSis�f A>J.Lip `? 9D0S> 3y7-0587 <br />TENANT MAK.ADDRESS CITY ZIP <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE STATE LICENSE[ <br />.... _._._. . r1!`3ii S�QY�I L-I.LV 1�1 IJCICI*T'� PHONE (STATE LICENSE[ <br />_ sv.,llu lt,� II Q:>Zj-UlSL/ SL11Jr�QT bz1 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE AT... I.Y... <br />CONTRACT PRICE OF WORK S 1� <br />j <br />+ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO Y <br />1„i,1.1,,r► can 1 �oatT [ �., <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 , <br />C'�� /� K" `�/a !9y <br />PROPOSED USE OF BUILDING %Of cL �ti� <br />LEGAL DESCRIPTION OF PnOPERTY (SHOWN BEELOWLOW O OR ATTACH TWO COPIES) <br />LOT BLOCK DI <br />PARCEL TAX I.U. NUMBER <br />1393 - CJ OU - (I O 7 .. O co <br />CONSTRUIDTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS go S g� <br />(' 'tT" � �[. 11 <br />snHAfurc off[ <br />cnr mnnn ssl K.rn;r rn <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 />; <br />FORCED AIR SYSTEM B.T.0 .A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />r <br />RANGE HOOD <br />LAUNDRYTRAY <br />' <br />` <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />r <br />WOOD STOVE <br />— <br />URINAL <br />_ ' <br />_ <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />, <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />Z <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />—;-- <br />SINK (SERVICE —BAR. ETC.) <br />; <br />T <br />r <br />—T— <br />r <br />r <br />r <br />SUB TOTAL $ <br />SUB TOTAL $ <br />'G U <br />PERMIT $ <br />r <br />PERMIT <br />TOTAL FEE $ <br />' <br />TOTAL FEE E <br />J' <br />FOR OFFICE USE ONLY: <br />f ROI:TSETRACK <br />REAR SET3ACK <br />SIDESETBACK <br />PLANCN CK NUMBE%� <br />ILL <br />TUCf IPT NO <br />S L <br />6SE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />FI YES fl NO <br />BUILDING <br />; <br />TYP! IX cros—, <br />NO OF STORIES <br />OHIAYNLY <br />FO a IMIILMG UNnf <br />sAaur <br />PLUMBING <br />I <br />SIZE OF BLDG <br />FIRE SPRINKLERS AEO'D <br />BASEMENT <br />MECHANICAL <br />�— <br />5, DO <br />❑ YES ❑ NO <br />ADDITIONAL PUN CHECK <br />---- <br />OCCUPANCY LOAD <br />FARE ALARM REDO <br />HEIGHT LIMITATION <br />OTHER <br />i <br />REASON <br />STATE BUILDING SURCHARGE <br />; <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />I <br />LOCAL SALES <br />TOTAL <br />i s ico <br />DATE <br />TAR CODE IS 3105 <br />