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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT - BUILDING DIVISION <br />3200 CEDAR STREET - EVERETT, VVA 98201-259-8810 4wff <br />F' DEMOLITION COMBINATION Fl BUILDING Fl MECHANICAL I PLUMBING I SIGN <br />PROJECT ADDRESS <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />A\Fr'ed v' S�.bit(t�rls�, nc. \7a\ \"k <br />ZIP Z PHCY,S <br />ARCHITECT OR DESIGNER <br />MAII. ADDRF.S <br />CITY <br />ZIP <br />PHONE. <br />FCNERAL CONTRACTOR <br />MAILADDnESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE. <br />MECHANICALCONTRACTOn <br />MAIL ADDRESS <br />rlTy <br />ZIP <br />PHONE <br />STATE LICEI:SE. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATELICENSE- <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: xGAS f I ELECTRIC fl <br />DESCRIBE WORK AND SQUARE Ftr )TAGE INVOLVED I n , ` 1 <br />tAI TL <br />CONTACT PERSON AND PHnuc up ;�I, 1 <br />P \i !hJ ,����( O`)yl y(.-- <br />y1'L 12 <br />/ <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />A'PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORT: WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN 01' <br />NOT. ;HE 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 Ol- THI5 PROFERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AN') I COMPLY WITH THE STALE <br />CONTRACTORS LA .27 RCW AN^ 296.200 WAG. <br />.L <br />PROPOSED USE OF BUILDINGPIIOVISIONS <br />LEGAL DESCRIPTION OF PROPERTY I'SHOW_N FLOW OR ATTACH TWO PIESI <br />LOT y 3 BLOCK4�.9 _ or_ <br />L_ A� I/ <br />D I IS1 DY�i 1"1 , OQFOWI rUor(ka ilk (L <br />(� <br />P-LOf C. <br />PARCEL TAX I D. N BE <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />- GNATUR DATE <br />LTBUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. OF EQUIPMENT FEE _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />�l <br />WATER CLOSET (TOILET) <br />_TYPE <br />A/C -A/HNDLGUNITS -H.R <br />BATHTUB ZVj <br />FORCED AIR SYSTEMS - B.T U. M E.A. <br />; <br />---T <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS-B.T.U. M <br />_ <br />KITCHEN SINK 8 DiSP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHERV <br />WATER HEATER (� <br />' <br />URINAL <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />; <br />METAL FIREPLACE (WOOD OU'INIKG) _ <br />FIREPLACE INSERT (WOOD B_URNiNG) <br />FL OOR DRAIN <br />' <br />_ <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />(SER\ ICE - BAR, ETC.) <br />_SINK <br />EXHAUSTFAN <br />' <br />SUBTOTAL $ <br />SUB TOTAL S <br />_ <br />PERMIT S <br />I <br />PERMIT S <br />�- <br />TOTAL FEE S <br />' <br />TOTAL FEE S <br />' <br />I FOR OFFICE USE ONLY: <br />FRONT SFTRACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBF <br />FEE <br />RECEIPT NO <br />USE Zo <br />I OT AREA <br />VACA�N,T�SITE <br />FEES <br />VALUATION <br />FEE <br />-1. 13 �p <br />r'�-. II NO <br />BUILDING <br />i <br />HEIGHT Lly1LLAT10N <br />/�6`L) <br />NO OF DWELLING <br />UNITS <br />SIZE OF BLDG'TI <br />213 Sf �,I Vi.J4 f <br />PLUMBING <br />I <br />' Cy _ <br />/ <br />y(.Z S G-oa,-c�-- <br />— <br />MECHANICAL <br />2 I <br />11 <br />OCCUPANCY NO OT 110P6 <br />OCCUPANT LOAD BASEMENT <br />Gnot <br />I <br />CL <br />3 V' I <br />N AYES NO <br />FIRE ALARM REO'0 <br />REASON <br />ADDITIONAL PLAN CHECK <br />i <br />I <br />OTHER <br />I <br />_ <br />FIRE SPRINKLER RF.O'D <br />REASON <br />STATE BUILDING SURCHARGE <br />1� <br />TYPE OF CONST <br />PI ANS APPROVED BY <br />CITY OF EVERETT <br />Pumc.. WORKS <br />Jr4 <br />LOCAL SALES <br />- <br />_ •�-hJ <br />DATL &j1je1q,5 <br />TAX CODE IS 3105 <br />TOTAL <br />i <br />