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+r T <br />�r <br />APPLICATIOmi FOR CONSTRUCT ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION n COMRINATInN 17 mini <br />..____..__. <br />3RQJECT ADDRESS <br />----- -- "�'��"•� I mrs HAIVHJAL I I PLUMBING SIGI <br />'7.30 --#-5:aP3 S_uJ. r-VP- T- M14LL &Vpy sWr� 1oY EV2%T li✓F1 <br />—.. . 9Sf�o3 <br />MLADDRESS CITY AIZIP PHONE <br />u. ennecee <br />OR <br />�I ZIP <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSE , <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSE N <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY <br />ZIP PHONE <br />STATE LICENSE & <br />CONTRACT PRICE OF WORK <br />$y1 %o m� <br />HEATING SYSTEM: Cl GAS I -I ELECTRIC Fl <br />CONTACT PERSON AND PHONE NO <br />RoAl 0-46o6s 776,-$�3S <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />hvSTIg6t (I) ser lAlroalol2 <br />LEiT12S — 2F SQ• FT. — O v BLD(r- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRO PF-4610ILOING <br />11 /, L D M <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.!_?-_3_ R/ -- /L <br />BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />S,5E f'}TTl PCHEO <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 />S/�2 ^000- CJO 1 - <br />00co <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />PARCEL TAX I.D. NUMBER <br />4EU/ /I—� <br />x ��T/ LL---// 7 <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />_ 02S/7Fl�o <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 />' <br />A/C—A/HNDLGUNITS—H.P. I <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />'T— <br />SHOWER' <br />UNIT HEATERS-B.T.U. M <br />I <br />1 <br />KITCHEN SINK & DISP <br />; <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />' <br />VENTILATION FAN <br />- <br />LAUNDRY TRAY <br />, <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />, <br />URINAL <br />' <br />WOOD STOVE <br />I <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />' <br />SINK (SERVICE -BAR, ETC.) <br />I <br />GAS RANGE <br />, <br />' <br />GAS PIPING <br />I <br />I <br />EXHAUST FAN <br />' <br />I <br />� <br />I <br />I <br />� <br />� <br />I <br />� <br />SUB TOTAL $ <br />) <br />SUBTOTAL $ <br />; <br />PERMIT S <br />I <br />PERMIT S <br />I <br />TOTAL FEE $ 1' <br />TOTAL FEE $ <br />' <br />rum vrrwt Ust LINLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE 5— <br />RECEIPT NO. <br />�A <br />r„ <br />�30 <br />.s/3— <br />USEZONE <br />14 AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />/ <br />— / <br />7 <br />FIYES ;-'NO <br />BUILDING <br />I <br />7� 1 <br />II€IGIIT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />PLUMBING <br />L <br />UNITS Nam.. <br />OCCU1PANCY NO OF STORIES <br />OCCUPANT LOAD <br />BASEMENTGROP <br />I <br />MECHANICAL <br />' <br />FT YES F1 NO <br />AL JITIONAL PLAN CHECK <br />I <br />FIRE ALARM RE00 <br />REASON <br />OTHER <br />I <br />FIRE SPRINKLER REO <br />REASON <br />STATE <br />STATE BUILDING SURCIIARGF. <br />TYPE OF C.ONST <br />PANS APPROVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />I <br />cJP" n LOCAL SALES <br />TOTAL <br />DATE Ib %%9 TAX CODE IS 3105 <br />i <br />