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APPLICATIC�1 EOR CONSTRUCT'�N PER�'�IT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM• ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT � <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />OWNER r MAIIAD�RESS <br />�: i.,.irwrr� W A'�khitc.� . 700 5�'� avG <br />TENANT <br />MAIL ADDRESS <br />❑ BUILD!":G <br />CITY <br />�'ve+N�r'� <br />CITY <br />❑ MECHANICAL ❑ PLUMBING <br />21P PF:ONE <br />�$Loc( S"�� —U2$9 <br />rnune <br />,� 365� <br />❑ SIGN <br />ARCMITECTUBDESIGNER MFILAD�RESS - - CITV IIP PHONE <br />bu�{9. Il�l I��n�t.St'�f4°3o3 .�'-Sea�ft,e `�5�01 22.3-�E4?`� <br />GENERALCONTRACTOR MAILAO�FESS CITV ZIP PHONE STATELICENSEM <br />�ur�1'+�E C�wss: RaS. 1�l l'f ��.�,o�rrrtvE- Searrcr R ui�5 282 7Soc S.e.a'�'t'G.�2.�uf g� <br />MECHANICAL CONTflACTOR MRIL ADDRESS pTV 71P PHONE STATE LICENSE P <br />�� <br />PLLLMBINGCONjBACTOR MAIIAU�RESS f,IN ZIP PMONE STqTELICENSEM <br />�ONTRACT PfiICE O�OflN <br />a`►� __ <br />DESCRIBE WORK AND SOUAPE FOJTAGE'NVOLVED CONTACT PERSON AND PHONE NO. <br />'�eNaoi' 3',Hn.p�� 5- 2�, �( t�15u ��. Zfi2-7 Soo <br />PROPOSED USE OF BUILOINfi <br />LEGAL DESCflIPTION OF PflOPERTV (SHOWN BELOW OR ATTACII TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXI.D.NUMBEP <br />CONSTRl1CTION LOAN LEI <br />OF PI%TUpE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER _ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />USEZONE LOTAREA <br />iYPE OF CONSi, <br />J—%V <br />SRECFBLDG. <br />�ra i��. <br />OCCUPANCYLOAD <br />INiAKE BV <br />I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br />APPUGATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANC[:S GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHE2THER 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 Sl'ATE <br />CONTRACTORS LAW 76.27 RCW AND 296.200 WAC. <br />Y� I� �,..�. �Z- ZS -q � <br />5� 1 i�.� i��-- \ 1 <br />L�{YBUSMESSL NSENO <br />MECHANICAL <br />FEE N0. TYPE OF E�UIPMENT <br />� lUC—A/HNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />i UNIT HEATERS—B.T.U. M <br />' CLOTHES DRYERS <br />' VENTILATION FAN <br />RANGEHOOD <br />; WATER HEATER <br />i WOODSTOVE <br />; METAL FIREPU�CE (WOOD BURNING) <br />� FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUSTFAN <br />PERMIT $ <br />TOTALFEE $ <br />NO.OF STORIES <br />� <br />FIRE SFRINNLERS flE0'D <br />NG' <br />FIRE ALAA`RM Rf.O'D <br />/✓ � <br />DATE <br />SIDE SETBFCK <br />VALANT SITE FEtS <br />CI YES ❑ NO BUILDING <br />OLCpGANtY NO O�VNEIIiNGUHi15 <br />caauP � p�Uh1BING <br />BaSEMErui MECHANICAL <br />❑ YES i�NO <br />HEIGHTIIMITAT10N A�DITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT pUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />� <br />SUBTOTAL $ ' <br />PERMIT $ � <br />TOTAL FEE S <br />� S� RECEI � %O. <br />l/ � <br />VALUATION FEE <br />� � I <br />i <br />i <br />i <br />i <br />; <br />; <br />� <br />� <br />