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A�PPLICATlLN FOR CONSTRUC'� .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> 17 DEMOLITION F3 COMBINATION J�' BItiLDING �Q MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS _ � O� �y f <br /> ' � 7� �� �► (N/,�� �1���'� <br /> OWNEq M LAUDRESS /,^ <br /> 1/mnRR ,' C�'� Nc �S JoNcS L-"I�;��-j� �r��c3 PHO� 2 �js3 <br /> S� /Ay�� J- MAILADDryyRESS [ / ��n. Z�P <br /> / I L ��� / �L' LQ W Jr �� 1 I A f�/7� � PHONE <br /> PFCMITECTOROESIGNER MAI�pDDRE55 CITV "v 76H� <br /> Z�P PHONE <br /> SNERA�CONTqqCTOR MAI�pDDPE55 CITV <br /> PNONE TAT.E,(-UCENSE� <br /> " �:�A ��J7� ti�i.�- ���s� Vf! ��ry��� 98'�6� s�� -/��2 �7�"- �5/ � <br /> .wsy�ca.ccr,�;,c�a mai�aooaess cm / /� `� <br /> v� PHONE STATB��CENSE 1 <br /> PLUMBINGCONTRACTOR MAIIpDDRE55 <br /> �� Z�P PNONE STATE LICENSE M <br /> NT RCTPqICEOF�IRN , ,y .—�^ � <br /> � 6 � ��/�� � ��-j r�^�Fi/Y/ /�;�r HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br /> D RIBE 'ORK ND SOUARE FOOTAG INVOL ED U CONTACT PEq N ND PHON <br /> �Mo� � R� �j`uc�.c,et- EN ' r.� nn <br /> ,a �i� y ;` —� IV�! .'aRNr E /_nc�= <br /> 1�4/I//�n;vs � ��,ps �' �S/O� y� �j� / �; _ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEJ THIS <br /> FROPO�SED USE OF BUILOING APPLICAI'ION AND KNOW THE SAME TJ BE fRUE AND CORRECT.ALL <br /> S/ 17/%'� ,{� � � % �� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAIDESCPirTIpNOFPROPERTV�SHOWNOELOWpqp77pCHTWOCOPIES) H'ORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR i <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY � <br /> OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION CNi THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTiiORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOq WHICH <br /> - APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ','�'�:EUqK L .NUMLER `/� ) CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> / _ �j^�-1 <br /> CONSTRUCiION LOAN LEN�ER,ADDRE55,TEIEPHONE NUMBEl7 / � U ., _ / � / �/�,j� — <br /> r-�f-� l� <br /> AT RE���O I� IMTF. / <br /> �J <br /> CITY BL'SINESS UCENSE NO. `�— <br /> PLUMBIN6 MECHANICAL '— <br /> _NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FU(TURE OR ITEM <br /> WATER CLOSET(TOILET) FEE , <br /> ' A/C—AMNDLGUNITS—H.P. �— r � <br /> EATHTUB � ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WqSH BASIN) � Q H�AT PUMP � <br /> SHOWER � <br /> ' UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � i CLOTHES DRYERS � <br /> DISHWASHER � � � VENTILATION FAN � — <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER.. � WATER HEATER � <br /> URINAL ` ' <br /> DRINKING FOUNTAIN '�, � �a WOOD STOVE , <br /> � O METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN '� � Q FIREPLACE INSE3T(WOOD BURNING) � <br /> BACKFLOW PREVENTERS �� ; GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) ,) ' <br /> � GASRANGE � <br /> ' O QAS PIPING � <br /> � EXHAUST FAN <br /> i <br /> i <br /> � <br /> � — <br /> i i <br /> � <br /> � <br /> SUB TOTAL $ � � � <br /> PERMIT � S!�9 TOTAL $ � <br /> g ' PERMIT $ � <br /> TOTAL FEE $ � TO�fAL FEE $ � <br /> FOR OFFICE l3SE ONLY: <br /> FRONT SETBqCN / qEAR SETBA�K / SIOE SET9RCN � PUN CHECK UMBER FEE RECEIPT NO. � <br /> ��� Zd 2 r> <br /> usezo�+/ LOTAREA VACANTSITE FEES VALUATION EE <br /> n•��s n r+o OUILDING y��3� �/ <br /> HEIGHTUMI�TION � NO.OFOWELUNG 52EOFBLDG?I. C r �7 � �'� �� <br /> � uNirs R�ntoo,.c}' '— <br /> �Y S,� /J .r�rt! PLU6IBING T_ <br /> OCCUPANCY NO.OFSTOPIES OCCUPANT'OAD BASEMENT <br /> GROIIP '� � MECHANICAL � <br /> �� 1 '�/A OYES �y(p � � Ol� <br /> FIP.EAURMREO'� REASON AUDIPONq�P�pNCHECK � <br /> i <br /> OTHEH i <br /> � FIRE SPRINKIER R[O'D PEASON i <br /> STATE BUIL�ING Sl1RCHqqGE � i <br /> TVPE OF CONST PLANS APPRpyEp gy 'S� -, <br /> y CITY OF EVEHE7T PUBLIC WORKS � <br /> �r LOCAL SALES --�� <br /> � /� onTe ;3 qs TAX CODE IS 3105 TOTAL LiC� ��r� <br />