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nI <br />APPLICATIC"I FOR CONSTRUCT'1N <br />PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE <br />PRINT <br />HEATING SYSTEM: ❑ GAS <br />J ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259 8810 <br />DEMOLITION <br />I COMBINATION BUILDING <br />1_I MECHANICAL <br />f7 PLUMBING I I SIGN <br />OWNER <br />AIL ADDRESS CITY <br />ZIP PHONE <br />TENANT <br />MAILADDRESS CITY <br />ZIP PNONF <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS CITY <br />ZIP PHONE <br /><rj N� <br />Mrt l Oa �js'r <br />F5 AI`6a,3125E <br />GENERALCONTRACTOR, <br />ADDRESS <br />ZIP PHONESTATE <br />E <br />5,61j�r <br />x <br />X iO CCI Al ) 5*19 / <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSE 6 <br />CONTRACT PRICE OF WORK <br />a. 2q/0- <br />AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />?DES,IdtWORK <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 1 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 FjOW,AND 296.200 WAC. <br />I. <br />s N+ru¢ ('4' `� BATE <br />car ausmT ss(wLNSL NU <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTKTN OF PROPERTY (SHOWN BELOW OR ATTACH TWO COP IE5IO' <br />Lor� BLOCK OF STD- �3 �U <br />PARCEL TAX' D NUMBER <br />' ONSTRIICTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />Al A' <br />PROJECT ADD SS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—ArHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />_ <br />UNIT HEATERS—B.T.U. M <br />SHOWCR <br />' <br />CLOTHES DRYERS <br />r <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />r <br />LAUNDRY TRAY <br />I WATER HEATER <br />' <br />CLOTHES WASHER <br />V/GOD STOVE <br />; <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />�— <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />' <br />FLOOR DRAIN <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />' <br />ROOF DRAINS—RAINLEADE9S <br />EXHAUST FAN <br />1 <br />SINK (SERVICE —BAR. ETC.) <br />_ <br />I <br />; <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />' <br />_ <br />PERMIT $ <br />PERMIT $ <br />I <br />TOTAL FEE $1 <br />TOTALFEE $ <br />' <br />FOR OFFICE USE ONLY: :k112Z rP dtt <br />FRONT SETBACK <br />zo ' <br />BEAR SETBACK <br />Zo <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE;IE" <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION— <br />FEE <br />/L � <br />/O 7 3 <br />e YES F7 NO <br />BUILDING <br />ZP� (0 <br />27 <br />Ti PEOCDNST <br />NO OF STORIES <br />ouuwxc. <br />cu v <br />xo awnulxc urns <br />I <br />PLUMBING <br />; ) <br />SIZE OF BLDG <br />1690 Sf't <br />0. <br />FIRE SPRINKLERS REGE, <br />O <br />BASEMENT <br />i !YES O <br />MECHANICAL <br />I <br />ADDITIONAL PLAN CHECK <br />-- <br />I <br />OCCUPANCY LOAD <br />A <br />FIRE ALARM, 1R1EOD <br />N 0 <br />HER:"-UMITA"ON <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY MANSnoveonv CITY OF EVERETT <br />PUBLIC WORKS <br />2r)I C;U <br />JAr I� LOCAL SALES <br />DATE f �r� 5 TAX CODE IS 3105 <br />ToT AL <br />