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APPLICATIC 1 FOR CONSTRUCT -1N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />BUILDIi IG DEPARTMENT <br />259-8810 <br />1 DEMOLITION XCOMBINATION 1 BUILDING I !MECHANICAL PLUMBING SIGN <br />0\YNER MAIL AOORESS CITY ZIP PHONE <br />;o�ooN H0145TENANT MAIL A02 2!° G�DRf� Ty ZIP PHONE <br />ST. �116J��Tj 98?-01 259-G042 <br />SiArM ir- PHONE <br />✓NYiT�vNlGNER mr-1 <br />//1l�LADDREBp P�s <br />45o2 l5 ' '• �. S6i1W-F <br />5t 32�1- 9300 <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSER <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE If <br />CONTRACT PI CE OFKjAO DOo <br />DES <br />i EWOR NDS UAREF TA # f; & 1'—fl„/_ <br />CONTAf E 0 *D C ESW�F� <br />b . Gmwp�17Lt7J <br />32q-83� ' C✓Z(o-55 <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 WIL!. BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />PROPON/1S�ED USpE OF pUILDItNG �-�• <br />SL/[�IAK SFpv)G S r0fj - Y014 1 <br />LEGAL DESCRIPTIONOF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT- OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />1 /BLOCK <br />/5�� <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 18.2 RCW AND 296.200 WAC. <br />PARc TA%J,D N M 50 / S O�n QO <br />OIRUCTIOtILO NLENDER. AD RESSELTEPI/HONEC/pAT <br />Vuffff <br />` <br />o1T11L <br />PROJEC/7jADDRESS Lr! ` Iy��/I�r �ba' <br />29 3 1 /NV J� \ V v V <br />C1TYIIu51%Fss Uoevst Na <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL S <br />SUB TOTAL S <br />PERMIT 5 <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />' <br />FOR OFI-IGt U't <br />_ <br />UNL.T: <br />PEAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />RECEIPT NO. <br />FRONT SETBACK <br />/6 <br />/O <br />USE ZONE <br />/0 <br />LOT AREA <br />VACANT SITE <br />7 YES NO <br />FEES <br />VALUATION <br />FEE <br />GQ �1 <br />C Z <br />BUILDING <br />PLUMBING <br />1` <br />TYPE OFCONST. <br />NO OF STORIES <br />=A" .0NMLLLhfu+uTS <br />O° UP <br />�„ 1 <br />q <br />FIRE SPRINKLERS REO'D <br />I <br />B EMENT <br />YES NO <br />MECHANICAL <br />' <br />SIZE OF BLDG. <br />,2 _yiJ <br />I_i <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />'?j Z <br />YPi <br />OTHER <br />REASON <br />Aft 6sellfl r <br />/ <br />STATE BUILDING SURCHARGE <br />/ <br />INTAKE BY PLANS APPROVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />JM LOCAL SALES <br />IS 3105 <br />TorAL <br />L; <br />TAX CODE <br />RANT <br />