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APPLICATIC -1 FOR CONSTRUCT'lN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS J ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />BUILDING <br />I MECHANICAL <br />PLUMPING 31GN <br />DEMOLITION <br />COMBINATION <br />_ <br />OWNER <br />MAR ADDRESS <br />CRY <br />ZIP <br />PHONE <br />GI rY o <br />Ev�R�SL, <br />W�TMoe� _, Ewe=_rT <br />yaZ41TENANT <br />MAIL AppRESS <br />PH N <br />- <br />�T OF <br />EA/ <br />SAME �N'S E <br />IP <br />PNONEU <br />ARCHITECT OR DESIGNER <br />- ----- <br />MAIL ADDRESS <br />CITY <br />1IA1I,—L�m L <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />GENERAL CONTRACTOR <br />MhIL ADDRESS <br />I Y <br />It <br />C �. <br />ZIP <br />PHONE <br />STATE LICENSE t <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />1, A <br />N <br />LITY <br />ZIP <br />PHONE <br />BTATE LICENSE t <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />0 <br />- <br />CONTRACT PRICE OF WORK <br />54.coo <br />E9TIMAT>✓ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />2.7 D S.F. <br />CONTACT PERSON AND PHONE NO <br />JcH N =F, L e_ <br />�Ia1T TMPBOve <br />ON FIR6-T ✓F1-002 WArLJ, EST SuIIAI�IG. <br />— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WI FH WHETHER SPECIFIED HEREIN OR <br />COPIES) <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOT BLOCK <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />D kII�T}ti Dl AVeJ�aErr" 9$zol <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO ."RFORM THE WORK FOR WHICH <br />� &N <br />( <br />APPLICATION IS MADE AND I '.. UMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAD. <br />I ` I��I� if� Q3 <br />I <br />.�_e4AL_ <br />PARCEL TAX t o um R <br />&41� - s7 �/� -O/o1�' _ <br />CONS�T/RUCTdION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />rI\ 1 <br />"TL <br />.� <br />PROJECT ADDRE'S <br />vr,NnronG� <br />CIlY B1151NCSS 11Cf 114[ NO <br />MECHANICAL <br />-- <br />PLUMBING <br />_ <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />_ TYPE OF EQUIPMENT <br />_ FEE <br />NO. <br />-� <br />WATE.-, CLOSET (TOILET) <br />A'C-A/HNDLG UNITS-H. P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />1 <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />KITCHEN SINK. 8 DISP <br />1 <br />CLOTHES DRYERS <br />VENTILATION FAN <br />- <br />'- <br />1 <br />RANGE HOOD <br />^ <br />DISHWASHER <br />WATER HEATER <br />�- <br />LAUNDRY TRAY <br />WOOD STOVE <br />_T- <br />- <br />CLOTHES WASHER <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />HEAT PUMP <br />GAS PIPING <br />--- <br />- <br />BACKFLOW PREVENTERS <br />:L <br />EXHAUST FAN <br />ROOF DRAINS-RAINLEADERS <br />+� <br />SINK (SERVICE -BAR. LTC.) <br />1 <br />�L <br />New Di JSC - <br />— <br />T <br />1 <br />SUBTOTAL $ <br />' <br />SUBTOTAL $_,. <br />-- <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />' <br />- <br />TOTAL FEE $ <br />FOR OFFICE USE <br />ONLY: _ <br />FRONT SETBACK <br />REAR SETBACK <br />USEZONE <br />LOT AREA <br />TYPE OF (ANSI <br />N0. OF STORIES <br />Z F12 <br />,yr �LQ 4 <br />SIZE OF BLDG <br />FIRE SPRINKLERS RED <br />2`f?05f T 11 <br />ifs <br />....�meurvl nen <br />FIRE ALARM RED <br />REASON <br />INTAKE BY <br />DATE <br />PLAN <br />VACANT SITE <br />rcca <br />❑ YES G NO <br />BUILDING <br />mcumn <br />NG 7 M11ING VITS <br />3GRIXIF <br />LY <br />f� <br />PLUMBING <br />MECHANICAL <br />BASEMENT <br />X YES 7 NO <br />ADDITIONAL PLAN CHECK <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />CITY JF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />RECEIPT NO <br />