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QPPLICATIO FOR CONSTRUCTr `N PERMIT <br />TO BE COMPLETED IN BLACK INK. --PLEASE PRINT <br />BUILDING DEPARTMENT ) HE TING SYSTEM: I)l GAS J ELECTRIC J <br />259-8810 <br />1 DEMOLITION COMBINATION BUILDING x MECHANICAL PLUMBING SIGN <br />1OWNER �MA: ADDRESSC,RY <br />�L1'j^'�5c <br />9009 <br />.PHONNE <br />6906) 63- 5)69L <br />�ZIP <br />TENANT3MAn AG <br />ZIP <br />Sgav1le. 0.5 Tx6UJ t <br />ARCHITECT OR DLSIGII0 MAIL ADDRESS CITY <br />ZN <br />PHONE <br />GENERAL COj RACTOR MAA ADDRESS CITY <br />ZIP <br />PHONE STATE LICENSE R <br />MECnANICALCONTRACTOR MAIL ADDRESS CITY <br />NIAi Woter i Ier-do-- .3110 dill Abe( Cyr(rit <br />ZIP <br />g83Ul��as9-15a�L <br />PHONE SITE LICENSER <br />IO(Z?1��'1�( <br />PLUMBING CONTRACT MAR ADDRESS CITY <br />71P <br />PHONE STATE LCENSEI <br />CONE I PRICE OF VIORK <br />2(/IyIL <br />DESCRIBE WORK AND 91 'ARE FOOTAGE INVOLVED <br />C T CT PE <br />50N A <br />('HO! <br />( <br />E NO 6� 3 51 a ,. <br />7v) t0. . C-1cxs i eev r <br />A <br />— <br />ry'rvvw-C(, wic�C) Run C" 9 L <br />1 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 />Y 1` Z4 <br />PRpOpsE_D UCE OF BUILCING <br />S F 2 <br />LEGAL DESCRIPTK)NOFPAOFERTY(SHOWN BELOW OR ATTACK TWOCOPIESI <br />LOT BLOCK OF <br />yy1�Rp1ELpTAA TAXI NUMBER '\ <br />'� n 4 5 ' 3 <br />CONSYdLCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PRECT ADD E <br />°�pb aB8 5t � ie °I68ClTvR1551NI5StlfI160 <br />9RNAipRfaI Q7 d n °"E <br />a m <br />1, <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />BATHTUB _ _ <br />LAVAT:IRY (WASH BASIN) <br />SHOWER _ _ _ <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRY TRAY _ <br />CLOTHES WASHER _ <br />URINAL _ _ _ <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR, ETC.) <br />A-C—AHNDLG UNITS—H.P. <br />—T� <br />' <br />_ <br />' <br />FORCED AIR SYSTEMS—B.T.U.5 E.A. <br />I <br />UNIT HEATERS-93.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />' <br />RANGE HOOD <br />WATER HEATER A <br />WOOD STOVE <br />_ <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />FIREPLACE INSERT <br />HEAT PUMP <br />; <br />GAS PIPING IeSF <br />_ <br />' <br />EXHAUST FAN <br />— <br />I <br />_ <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT— $ <br />TOTAL FEE $ <br />TD <br />PERMIT E <br />TOTAL FEE $ <br />r-nA OFFICE LISP ONLY: <br />FRONT SETBACK <br />REAR SE TRACK <br />SIDE SETBACK <br />PLANCH KNUMQF - <br />1 <br />RECEIPTNO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />--' YES NO <br />BUILDING <br />TYPE OF COHSE <br />NO OF STORIES <br />rccuaNcr <br />Na IKLMtIIAGus`!l <br />PLUMBING <br />' <br />SIZE OF BLDG <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />MECHANICAL <br />' <br />' <br />YES NO <br />- <br />ADDITIONAL PLAN CHEOc <br />I <br />OCCUPANCY LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />OTHER <br />I <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PURI IC W:JRKS <br />; <br />LOCAL BALES <br />TAX CODE 19 3105 <br />TOTAL <br />DATE <br />