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Ai -0;'La ATIC 01 FOR CONSTRUCT"lN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />T <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ DEMOLITION ❑ COMBINATION p C9'BUILDING CYMECHANICAL p-PLUMBING [I SIGN <br />ROJ CT ADDRESS: £3014— B Q.2nA3,u� KtLQ <br />1fk", W,-W-1 6322 7/.ttiIk. t u 7-33 -2 9 <br />TENANT MAIL ADDRESS CITY TIP PHONE <br />MAIL ADDRESS <br />Clt <br />PHONE <br />UJI+�1tCOCr&u•-1a�A <br />Li22 <br />76 <br />tZIP <br />E2y0 <br />337-3S24 <br />F147J <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE• <br />MECHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />DP <br />PHONE <br />STATE LICENSE <br />STATE LICENSE - <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />CONTRACT PRICE OF WORK <br />77 �(�� <br />,� <br />HEATING SYSTEM: L�TGAS ❑ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE W VCLVED <br />IUFw SF2 12SW SF <br />FAMBLE/Z <br />C -.NTAr PERSON AND PHONE NO <br />Ljsr 1,)�L1. 33�-3c,79 <br />.I <br />S F P. GL�1 L <br />/� I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS <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 REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WAICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.-27\RCnW 'AND 296.200 WAC. <br />PROPOSED OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY ISI(LVN BELOW OR ATTA HT wa corlEs <br />LOT Z BLOCK _OF <br />1 1 <br />PAM y ` l CI S D O <br />—T4 <br />3q 3 q OOS U Z 9001)-7 <br />P EL TAX I D. NUMBER � .1 � <br />N N mVM. . 775- <br />iAIICDON LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SKjNATURE DATE <br />CITY EUSINESS LICENSE 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 />' <br />A/C —A/HNDLG UNITS <br />�— <br />BATHTUP <br />/ <br />FORCED AIR SYSTEMS <br />; <br />y. <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />/ <br />KITCHEN SINK 6 DISP <br />;III <br />CLOTHES DRYERS <br />/ <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />/ <br />I WATER HEATER <br />; <br />/ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />; <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />) <br />FLOOR DRAIN <br />1 <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />3 <br />GAS PIPING <br />_ <br />I <br />'_3 <br />EXHAUST FAN <br />I <br />, <br />SUB TOTAL <br />S <br />; <br />SUB TOTAL S <br />; <br />PERMIT <br />$ <br />I <br />PERMIT S <br />I <br />TOTAL FEE <br />S <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />PEAR SETBACK ) <br />SIDE SETBACK <br />PUN CII5 rEF <br />nFf.EIrr NO <br />3MI}Frl 7 <br />/ f 7 1 <br />USEZONIGEJ�J/J/ <br />LOT AREAL�A�(J/)� <br />VACANT SUE <br />FEES <br />VALUATION <br />FEE <br />[]YES O NO <br />nU1(nING <br />-? / r <br />IHEIGHT <br />LIMITATION <br />NO OF DW LLING <br />UNITS <br />SIZE OF BLOGZrI <br />`L /U C ` <br />•IBAASEMENT y/�_• <br />PInMnIN(: <br />MECHANICALGRO <br />—_ <br />//J 3OCCCUPPANCY <br />���•••Jfff/(���7/�(/ <br />NO OF SIORES <br />OCCUPANT LOAD <br />.3 J <br />I <br />OYES IYNO <br />ADDITIONAL Pt W CIIFCK <br />FIRE SPRINKL REOV <br />REASON <br />---- <br />DINER <br />0 <br />FIRE AURM REO'D <br />REASON <br />--- <br />SIAIEBUI(DING'llnCHAnGE <br />TYPE orCONSr <br />r;nesnrrnnvEDDr <br />CITYOFEVERETT <br />PHIU,CwenKs <br />—sue —' <br />LOCAL SALES <br />---- <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />