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APPLICATIOd FOR COWSTRUCI iONl PERMIT i <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET" • EVERETT, WA 98201 •259.8810 <br />11 DEMOLMON (-I COMBINATION F1 BUILDING n MECHANICAL r-I PLUMBING i SIGN <br />OJECT ADDRESS /�� <br />//D � J !)� %,�'.�' fit'>ii �y� All lloa� <br />;R MAIL ADDRESS CITY ZIP PHONE <br />/I➢ �7 ��r 1�G4(!!J 7C1 (.Jfr7 CLf D CDV&A/b5 ',IEOZ-0 <br />"NANT / MAILADDRESS TY r- ZIP PHONE <br />3- L �.rAJACLC-2cb JL�+9m 2-9: 9CD <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONF <br />MECHANICAL CONTRACTOR MAIL ADDRESS ^.ITV ZIP PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS ^ITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: f -IGAS r) ELECTRIC fT <br />DE RIBS WORN AND SQUARE FOOTAGE INVOLVED <br />e�F <br />CONTACT PERSON AND PHONE NO. <br />&?PA I LL- ayA.![a 4w A o *29 <br />i <br />e,- -- <br />�A(l <br />'AND EXAMINED THIS <br />APPLICATION BY CERTIFY THAT ( HAVE D AND KNOW THESAME 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 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. /JI <br />X L !l7 �7 4,� <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />- Z- 000 - co8 <br />PARCEL TAX 10. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />SIGNATURE DATE // / <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C -A/HNDLG UNITS •-H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />I <br />UNIT HEATERS-B.T.U. M <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES bRYERS <br />DISHWASHER <br />I <br />VENTILATION FAN <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />; <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />I <br />URINAL <br />I <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PRE_VENTERS <br />GAS FIREPLACE <br />; <br />SINK (SERVICE -BAR. ETC.) <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I <br />. <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />; <br />PERMIT $ <br />I <br />PERMIT $ <br />I <br />TOTAL FEE $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: 4 ,-�%'7 &q ¢-,o5nead1A Pr . <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK/ <br />PLAN C"ECq NUMBEER� <br />FE <br />RECEIPI NO. <br />9U/F/_EES <br />USEZONE <br />LOi MEA <br />SITF <br />VALUATION <br />FEE <br />BUILOING S HELL <br />8 o' <br />; 9 <br />— c' —I <br />qIACA,NfT <br />7p 'z'z <br />s r; No <br />HEIGHT LIMITATION l <br />NO. OF <br />SIZE OF CLDG/TI <br />UNITS / <br />PLUMBING <br />/ <br />OCCUPANCY <br />NO Or STORIES <br />OCCUPANT LOAD BASEMENT <br />MECHANICAL <br />I <br />�7 ((�� <br />/" OE �F7F2�)/A�! AYES NO <br />ADDITIONAL PLAN CHECK <br />I <br />I <br />FIR[ ALAFIM RED'D <br />REASON <br />C rry D120/nlq.✓[� <br />` s <br />OTHER <br />.SPRINK <br />FI LER REO'D <br />REASON <br />No <br />STATE BUILDING SURCHARGE <br />TYPE OF F,ONST <br />PLANSTjOVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />^ / <br />LOCAL SALES <br />-C <br />V ' v <br />DATE J- a s 4" av, CODE IS 3105 <br />TOTAL <br />_ _ <br />