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APPLICATICA FOR CONSTRU :T.JN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8810 <br />I HEATING SYSTEM: A GAS ] ELECTRIC ❑ I <br />DEMOLITION <br />COMBINATION <br />BUILDING <br />MECHANICAL PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />3311 v ^,rno <br />-� <br />gb2-01 2s,5•'(4515 <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL <br />CITY ZIP PHONE STATE LICENSE A <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />C ►-I <br />-n- t L4AAn"�+ P�) bOy(- 3 3 a �2'7-7-3 , u $ 9'-L-tcxal "A 1;4k Ah I_tz.y", <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 21P PHONE STATE LICENSE A <br />CLASS OF WORK <br />NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPI. INSERT BUILDING RELOCATION <br />1 ` <br />CONTRACT PRICE OF WORK ( U ) <br />CONTACT PERSON AND PHONE NO. <br />T�%�jl K.t 4�5-y4 L) <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CaM <br />PROPoSED USE OF BUILDING <br />G <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 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 />Zy LA <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />LOT BLOCK OF <br />ADDRES'R. 1j <br />1 W T <br />TV <br />S Anmc �,y T OI D.TE <br />CITY BUSINESS VCENSE NO <br />PLUMING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P. <br />BATHTUB <br />5 <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-F.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />META'. FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />l0 <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN — <br />SINK (SERVICE -BAR, ETC.) <br />' <br />T <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />15 C) O <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />TYPE OF COINS. ALLOWABLE <br />TYPE Of CONINI ACTUAL <br />UCCUTANCY <br />NO M MTILNGIJVIS <br />"0" <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD FIRE SPRINKLERS REDO HEIGHT LIMITATION <br />_ <br />I <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />