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APPLICATIvN FOR CONSTRUC'h dON PERMIT <br />CITY OF E• BUILDING DIVISION <br />3200 CEDAR STREREETT - EVERETT, WA 98201 •259-8810 <br />n ncur T.I. OOL <br />..L.n VLlllvn 1 1 COMBINATION /� BUILDING I I MECHANICAL l i PLUMBING rl SIGN <br />PROJECT ADDRESS 2107 64(;Y AvFfx6, EvvwT wA. <br />)WNER MAIL ADDRESS <br />CITY 71P <br />_U/LfJL G1CG�j Nt 5, l► -- 'z70 CDI.ISYAVE.5I11T6118 Wk`i8?Af 2 1-"I�a <br />TENANT I MAIL ADDRESS + EVERETT, <br />V EKETT P�` CITY JIP PHONE <br />r1YL/YIt.Y� auk 2707 Go(,pSYJ�v�. 5c9►T� bC� GVf:l 2s8.3r 4s <br />AN 11TCCT OR DESIGNER MAIL AppRE55 <br />ONC�T� AuAkl 11�. ONE <br />(�0 Tom V- SEATTLE,Iuk"9b(ol 2`f2_ �283 <br />GENER/LCONTRACTOR 6AILADDRE11 cNy <br />]IP PfIONE c'iTE LICENSE, <br />t, Go[CP 3tso RESS iV)S KD S.E, tSEtCEV�x,w�_`( 5 -`lam <br />MECHANICAL CONTRACTOR MAILADORESS CIT. — <br />ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY - <br />ZIP PHONE STATE LICENSE <br />!1 4i! G-,- . Oo <br />HEATING SYSTEM: S t GAS I] ELECTRIC n <br />DES IBE WORK AND SQUARE FOOTAGE INVOLVED _ L` <br />CVl'�lo1�S O 0 <br />CONTACT PEPS N AND PHONE NO <br />li RA-71 f52 W2:�I, <br />21 11a SQ. rpt .9 ICE -a)ITF, <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED <br />PROPOSED USE OF BUILDING <br />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 COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES( <br />LOT II BLOCK Z4_DF Tof SVFtzE1 r <br />NOT. THE GNOT PRrSUME TO <br />AUTHORITY TOT VING IOLA EPERMIT <br />CANCELS THE PROVISION OF AINY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />A�. <br />✓WNE O <br />TS <br />p`, . <br />32 <br />I /��it <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />�� ?� J -iJ2 <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK cOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR CTORS L 8.27 RCW AND 296.200 WAC. <br />PARCEL TAXI D. NUMBS I <br />SEG hTTi�FtHEUT `h" <br />� - <br />CONSipUCTIDNLOgN�r�TELELHONFIJuk1BEq <br />1�.�/T Y/1� <br />'/✓ram/�[/` /1` <br />XGNATURE(i iC <br />D(AT.YEj <br />PLUMBING <br />CITY BUSINESS LICENSE NO. <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />MECHANICAL <br />NO. TYPE OF FIXTMITEMFEEWATER <br />CLOSET (TOILET) r'A/C <br />— AMNDLG UNITBATHTUBFORCED <br />(WASH BASIN) <br />AIR SYSTEMLAVATORY <br />HEAT PUMPSHOWERUNI7 <br />SINK & DISP <br />HEATERS—B.T.KITCHEN <br />CLOTHE_S DRYERS <br />DISHWASHER <br />LAUNDRY TRAY <br />1 <br />' <br />VENTILATION FAN <br />RANGEHOOD <br />�- <br />CLOTHES WASHER <br />'r— <br />URINAL <br />WATER HEATER <br />- <br />' <br />WOOD STOVE <br />1 <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />' <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />i <br />1 <br />GAS RANGE <br />- <br />GAS PIPING <br />EXHAUST FAN <br />1 <br />F� <br />I <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />PERMIT $ <br />, <br />G1Fl l�r•�u+� <br />TOTAL FEE S <br />. <br />TOTAL FEE S <br />FRONT SETBACK <br />USEZONE <br />REAR SETBACK <br />LOTAREA <br />SIDE SETBACK <br />VACANT SITE <br />CKON `MOER� FEp�n ��� <br />FE((II�`EjjS �/J VALUATION <br />RECEIPTNO. <br />FEEn),ES <br />❑ NO <br />/1"EIGHT OOj <br />LUNITS <br />LIMITATION <br />NO OF DWELLING <br />SIZE OP BLDGIT 1.T <br />197OCCUPANCY <br />NO OF STORIES <br />OCCUPANTLOAD <br />pp <br />BASEMENTGROUP <br />17YES (l NOFIRE <br />AL39 <br />Mk! <br />ALARM REOD <br />yr <br />REASON <br />E csrc <br />L PLAN CHECK <br />_ <br />' <br />�TIRE <br />SPRINKLER REO'D <br />TYPE OF CONST <br />I rl(Z, <br />REASON "-DING <br />PLANSA`PRROVED by CITY OF EVERETT <br />LOCAL SALES <br />SURCHARGE <br />PUBLIC WDRKS <br />ii <br />L <br />' <br />TOTAL <br />_ - 17 <br />7 <br />/")hh <br />DATE - - g (✓ TAX CODE IS 3105 <br />