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APPLICATB�..� FOR CANSiRUC7.JN PERIVIIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR S'fREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION fl BUILDIPJG rl MECHANICAL ❑ PLUM8ING ,PQ SIGN <br />PROJECT ADDRESS � <br />CaSOo Cv�i�Ur�.c��v w�� y, r"Vi_�2.�'Tr w�g, 98�03 <br />OWNEB MAILAU�RGSS QTY 21P PIIONE <br />Cnnn.� A�ci u � � <br />C/��p/ST�roNCN�i?cH G�Uo CVEl�U��'rN u.v�y EG'tiiT 95p,o3 <br />TENANT lANLnDDqE55 CITY ZIP PIIOP'F. <br />SA�vI L <br />ARCHITECTOi'.OESIGNER MAILADDRESS GITV/ ZIP PNONE <br />U�k.��4�.V _Fa�vco. F'-o. Fiex S�6 7 LGi.�n wU o d� kl�{' /�� �%�J ��% �a— ��J� S <br />GENERALCONTRACTOR MAlI.A0DPE5S t� CIN ZIFl PHONE STATEUCENSEt <br />MECH�NICAL CONTPACTOR <br />IINCaCONTRhCTOR MNLA�ORESS <br />a 8:�'4� ``—' <br />IAC PfiIGE OF WOFlK <br />� <br />//.IL = <br />�RE FOOTAGEINVOLVEU <br />/L �, �M ! N/� T r' ,�j <br />%//.� f / /i <br />�— r <br />kZ <br />�' / ���/ � 2 <br />LEGAL OESCRIPTION OF PPOPERtt �SHOWN �ELOW OR ATTACH TWO COPIES� <br />�oT BLOCN or <br />�'�E� /�LOT %�LF�/i( <br />3930 -� o00 - o�/ -- o oa 6 <br />PAflCEITA%I.D.NUMBER <br />CONSTRUCTIONLOAN LENDER,ADURESS,TELEPNONE NUMOGR <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY 1WASH OP.SIN) <br />KITCHEN SINK & DISP <br />DISHWASHER <br />CLOTHES WASHEP <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — BAR, <br />Pf{ONE <br />STATE LICENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />WNTpCT PEFiON AND PFIONE NO <br />�NG- �'Tk'Eir FuLToti/ '77 G� -�s 3 S <br />FEE <br />_ I SUB TOTAL S <br />j PERMIT S <br />TOTALFEE 3 <br />FOR OFfICE USE ONLY: <br />F30NTSETBACK R[4RSET0 �� /� SIDE��BACN <br />�l6 <br />US[ ZO r� LOT r1R VACANT 517E <br />�7VF5 ❑ NO <br />HEIGHT LIlAITATION NO. OF DWELIING SIIE OF �IDG.TI. <br />UNITS <br />OCCUPAN�I I NO.OFSTORIES I OCCUPANTLOAD <br />GROUP <br />❑1E° Cl NO <br />X <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED IHIS <br />APPLICATION AND KNOW THE SANE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGU�ATING CONSTRUCTION OR TFfE <br />PERFORMANCE OF CONSTRUCTION. TFIAT I AM AUTHORIZED BY THE <br />OWNER OF TFIIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 2f�o200 WAC. <br />X �/J1.Gry��V-�"' a � �^ �'/.S <br />SIGNATURE OATE <br />CITV BUSME55 LICENSE NO O J—y %� G <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C —AMNDLG UNITS — H.P. � <br />FORCcDAIRSYSTEMS—B.T.U. M E.A. ' <br />HEAT PUMP �— <br />UNIT HEATERS — B.T.U. M . ! <br />VeNTILATION FAN <br />PANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASPANGE <br />GAS PIPING <br />EXHAUST h-.4N <br />(�WNlNG 5 <br />SUB TOTAL S ; <br />PERMIT $ � <br />TOTAL FEE 5 ! <br />PLAN CNECK NJld�ER I FEE ,��/O <br />i i/�%/�? <br />OUILOING <br />PLUM�ING <br />MECHFNICAL <br />A�CITIONFL PLAN LHECN <br />OT!{ER <br />STATE OIIILDING SIIRCHARGE <br />PIl�NF�YPIipv�ur CITY OF EVERETT ��BUC\VORKS <br />a�� LOCALSALES <br />onre `�:1 _q _�ii TAX CODE IS 3105 70TAL <br />