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r <br /> ppPLi�AT1�..1 FOR CONSTRUC'� .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETf, WA 98201 •259-8810 <br /> FW JpAT10�1-� <br /> ❑ DEMOLITION ❑ COMBINATION 5a BUILDING ❑ MECHANICAL ❑ PLUMBING fl SIGN <br /> PROJECT ADDRESS ,f�le�I ������ �j{Y <br /> _er�a <br /> OWNER MRILAD7RESS CITY ZIP r'HONE <br /> J�,t I�IC�NATA2o lo5a� &vEec�E��u1a'/ ��E2�T 96"�o4 Ca.�r�� 39B - 3141 <br /> TENANT <br /> MAILA�OHES CITV [ PHONE <br /> �RCHITECTOR�ESIGNEF MPILADDRE55 <br /> CITY ZIP PHONE <br /> fREp po�cou-� <br /> � GENEqpLCONTRRCTOP MAILADDRE55 CITY ZIP PHONE STATELICENSEN <br /> � � 0 8ox W3o rlryKi��Cv Z98a'�5 ��5`g%�� STATEICN���� �oJ <br /> , MECHRNICALCONTRACTOR MAILADDRESS <br /> PLUMBIN6CONTRACTOR MAILADDPESS CITV 21P PNONE STATELIGENSEN <br /> CONTRACTPRICEUF WORK HEATING SYSTEM: .�ci GAS ❑ELECTRIC ❑ <br /> DESCRIBE WOflK AND S�UARE FOOTAGE INVOLVED <br /> CONTA RS ANO PH NO. � <br /> Fr�i/.t//�ili/D•t/ GN/cY �/o� — <br /> o�rs�v� MN• ��C /� 7 <br /> /S . 800 ST <br /> � I HEREBY CEFiTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED USE OFBUILDIN(i PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> f��v ��J��i�� AN/) JEf1LCZ��P WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEQAL0E5CRIPTIOPIOFPROPERN(SHONMBELOWORATfACHTWOCOPIES) NOT. 1'HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> POallto/J � £ 3 C!i Y OF Gi/ - - AUTHOflITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> of ��T BLOCK oF OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 7 8� �cSP RELD�OG� PERFORMANCE OF CONSTRUCTION.THAT i qM AU?HORIZED BY THE <br /> ��� � OWNER OP THIS PROPERTY TO PERFORM THE WORK FOfl WHICH <br /> �nJ%J�=J� /'2�. No. �7oiZ2oa36. ` ,qsr� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> d v� CONTRACTORS LAW 1827 RC�D 296200 WAC. <br /> PARGELTAI(I.D.NUMBER ZQ Z SG I ' Z— O� '- � • �J � y�y/ <br /> 7 � ' _ � ��D �-v / CL <br /> CON57RUCTON LOAN LEN�ER.ADDHE55.TELEPHONE NUMBEF X OATE <br /> SIGNAT <br /> CITY BUSINESS LICENSE NO. __ <br /> PLUMBING MECHANICAL <br /> FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> NO. TYPE OF FIXTURE OR ITEM � <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. i <br /> BATHTUB ' <br /> LAVATORY(WASH BASIN) ' <br /> HEAT PUMP ' <br /> � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' <br /> ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP _ ' <br /> i VENTILATION FAN � <br /> - DISHWASHER � <br /> LAUNDRY TRAY ' RANGE HOOD ' <br /> , WATER HEATER ' <br /> CLOTHES WASHER yypOD STOVE � <br /> URINAL � <br /> � <br /> ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ' <br /> � FIREPLACE INSERT(WOOD BURNING) ' <br /> FLOOR DRAIN ' <br /> � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING �-- <br /> � <br /> ' EXHAUSTFAN ' <br /> i � <br /> i <br /> i <br /> � ' <br /> � T <br /> i <br /> � <br /> SUB TOTAL $ � SUB TOTAL S � <br /> PERMIT S ' <br /> PERMIT S � <br /> TOTALFEE $ ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: �V <br /> PLpN CIIECK NUMBER FEE RECEIPT NO. <br /> ��, <br /> FRONT SETBACK REAR SETBACN SIDE SETBACK � // ���.i� � - <br /> FEES VALUATION FEE <br /> USE ZONE LOT AREA VACANT SITE � <br /> �NoT�. ' <br /> Il VE5 n N� BUIL�ING � <br /> i <br /> HEIGHT LIMITATION NO.OF DWELLING 512E OF BLDGR.I. � <br /> UNITS N Z SDOU PLUMBING ' <br /> i <br /> OCCUPA V NO.OGSI0PIE5 OCCUPANTLOAD BASEMENi MECHANICAL � <br /> ,�'(�jUP p Z ��3� ❑YES [l NO � <br /> /1 , u AODITIONALPLANCHECK � <br /> i <br /> FIRE ALARM REO'D REASON i <br /> / �5 1 <br /> � OTHER � <br /> i <br /> FIRE SPPINKLER REO'0 RFASON � <br /> YSTATE OUILDING SUfiCHARGE � <br /> �S � <br /> TVPEOFCONST PL/1NS�P OVEUBV CITY OF EVERETT PU�LICWORKS � <br /> �f1n LOCAL SALES � <br /> �I� � y S !. TAX CODE IS 3105 TOTAL ' <br /> � - DATE .�-��' <br />