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APPLICATIC"1 FOR CONSTRUCT'"IN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTM NT HEATING SYSTEM: U GAS U ELECTRIC LJ _ 1 <br />259.8810 1 7U%„L_ CC 1904 D e 7�a Sea- y' ia/ j2a - 3i«l <br />❑ DEMOLI1ION ❑ COMBINATIONS ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING )SIGN <br />R NiNnEoorA�6 Co.Etiffd AILAD09630 &to F, � WCITV�AWWDOD ZIP�o34 PHONE <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />A+/fKv,✓dS AM4 <br />ri1�i�C <br />3e5*.$ <br />kqy <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE# <br />�y_slon� Co�P <br />/2Ss <br />G��S�iAXf <br />Al UcAMn <br />9S//9 y82-o700 <br />�/�f'(;O -ffz <br />MECHANICAL CON THACTOd <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE# <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK J <br />D <br />DESCRIBE WORK AND SOU#IE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />if+sma (1) s��rF Ggc� o.uMuwEo w z. <br />51E►'EZdol0jF t4 24z-o loo <br />o•4/ IfWj Pf'6 EMM . . <br />1 HEREBY CERTIFY THAT' I HAVE READ AND EXAMINED THIS <br />APPLICATIO.J AND 'KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK V".LL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G.JE <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 14ADE AND I COMPLY WITH THE STATE <br />CONTRA TORS LAVJ48.27 RCVy AND 296.200 WAC. <br />PROPOSED OEE GF BUILDING <br />Arflft <br />LEGAL DESCRIPT;ON OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />6 9 <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS �1 `'= n ///yam/�T <br />slcNAr DATE <br />CITYDU NESSI-C[NSL NO <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 />A/C—A/HNDLG UNITS—H.P. _ <br />BATH. LIB <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 & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />ROOF DRAINS—RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />NEAR SETBACK <br />SIDE SETBACK <br />PLAN CHEC NUA tF13 <br />I/ <br />FEE _ ` ^ <br />JKV'ALUA(TTIION <br />RECEIPT NO.O3 <br />/) (/IOFEE <br />USE <br />LOT AREA <br />VACANT SITE <br />FEES <br />JZONE <br />A-L, <br />❑ YES ❑ NO <br />BUILDING <br />i — <br />— , <br />TYPEOFCONST <br />NO.OFSTORIES <br />XCVA <br />Na.ffo UxcuNITS <br />GRNP <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />' <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />, <br />REASON <br />T <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLAN SAPPR VEDBY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />�I l <br />LOCAL SALES <br />DATE i. <br />TAX CODE IS 3105 <br />TOTAL <br />/ ` - <br />0.95 <br />• <br />