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+9 <br />APPLICATION FOR CONSTRUCTWN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 90201 9259.8810 <br />1EMOLITION ❑ 'COMBINATION ❑ BUILDING 13-MECHANICAL ❑ PLUMBING ❑ SIGN <br />�/ r (' /? 1J <br />PROJECT ADDRESS: cwee� <br />I��nck�w��er �; eo %Uev�Tv� ��iv�, J �S <br />Tit I / / 7'lot,eul <br />ES5 /nD�� J Clf� ZIP <br />� of D�PI10SV3 <br />ENAN I X L- <br />," �` V MAIL ADd15S \ ITY ZIP PHONE1(„1\Int JIL1 r �; anEre4lIjP 3N. <br />IIf.IATCCT OR DESIGNER MAIL ADDRESS CITY TIP PHONE <br />^.•. nAplul MAILALIUHL55 CITY TIP PHONE STATE IICENSEI <br />�NLTYI II I �N l tn! I � 1 P4 <br />MECHANICAL CONTR O(l <br />MAILADDRESS <br />CITY TIP PHONE <br />STATE LICENSE <br />s e Eri�' <br />y <br />177 S N ,IIE,I� <br />� A►O1Z 763-I�(4 <br />Eyevni <br />PI IIMBIN CONTRACTOR <br />MAIL ADORES$ <br />AILADDR <br />CITY <br />CITY ZIP PHONE <br />$TAT ICENSE• <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: W GAS ❑ ELECTRIC El - <br />DESCRIBE I K AND SOUARE FOOTAGE WVOLVED <br />S <br />Pc. <br />r, A T PERSCN D P E NO \ <br />r A <br />L J S mIk <br />Judi <br />11004I, <br />TT`�I <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 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 />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 jS—MADE AND I COMPLY WITH THE STATE <br />CONTR CT R'� LA !7ND 296.2DO WAC, <br />PROPOSED USE 07U.7, <br />i <br />LEGAL DESCRIPTION OF PTIOPERTY ISHOWN BELOW OR ATTACH TWO COPIES) <br />BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />510 TURE A <br />CITY BUSINESS 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 —AMNDLG UNITS <br />' <br />_ <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />' <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR. ETC.) <br />I <br />GAS PIPING <br />I <br />' <br />EXHAUSTFAN <br />' <br />' <br />I <br />I <br />I <br />, <br />I <br />I <br />I <br />I <br />SUB TOTAL <br />S <br />SUB TOTAL $ <br />PERMIT <br />$ <br />I <br />PERMIT S <br />/ I <br />TOTALFEE <br />S <br />' <br />TOTAL FEE $ <br />' <br />Fnw nFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />USE ZONE <br />IOTAREA <br />HEIGHT LIMITATION <br />NNI OF DWELLING <br />TS <br />UECCIIPANCY <br />Ir <br />NO CA STORIES <br />OCCUPANT LOAD <br />FIVE SPRINKLER REO'D <br />RFASON <br />FIRE ALARM TIED <br />REASON <br />TYPE Or r.ONST <br />PLANS APrROVEO! <br />DATE <br />