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APPLICATIO►_ FOR CONSTRUCT{ ,N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION [BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS' S/' �y CNr'�L rE % F✓� AZi= �, <br />E)6?01 iY"7i ,g c. 47 e'�cx SLY r✓i. `%.��✓ l .�5=s- 3Sn <br />OWNER AIL ADDRESS CITY ZIP PHONE <br />CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY 71V PHONE <br />fBociry Co/JSi 1,Uc /11uk1'JiPo I1A• 4,ez3 <br />� (��[a�53-7014,11t/ITx i„/nrF <br />GENERALC TRACTOR MARL ADDRESS CITY ZIP HONE SLATE LICENSE It <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />.from /'. . =_>;� —O <br />CONTRACT PRICE OF WOLLW <br />Y/d7do . e0 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK WORK AND SQUARE FOOTAGE INVOLVED _ .V <br />o.oC' <br />CONTACT PERSON AND PHONE NO <br />I 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 IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X�2 '✓}/!�(II IK/. % iLJ! • �O -/ —� <br />PROPOSED USE OF BUILDING <br />LiECIC Ai Nnnn) - L)E-iUKITitC - 9S <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT N BLOCK FCCNAtAPlFi=OF o_ )= <br />So IN Le c H 412c BF_ E 7T SJL T <br />') =12 ft <br />PARCEL TAX I.D. NUMBER <br />._ L_ ? Fiji. Zo <br />7NXV LOAN {ENDER, E S. TELE /Z� BERL <br />✓,LE,7-J �� / (L'] / U !�_ <br />SIGNATU r DATE <br />Y BUSINEES LICENSE NO %�O�6 I_ <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—AJHNDLG UNITS <br />�— <br />BATHTUB <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />' <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />; <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />; <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />' <br />' <br />EXHAUSTFAN <br />i <br />I <br />; <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT S <br />I <br />TOTAL FEE S <br />' <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />" <br />RFAn SFTBACK <br />' <br />SIDE SETBACK <br />PUN CHECK NUMBFn <br />TEF <br />nFCFIPT NO <br />o <br />10 <br />5- <br />3C <br />USEZONE Q/ <br />IOTA E/ <br />VACANT SITE. <br />FEES <br />VALUATION <br />FEE <br />{-� <br />L-� <br />OYES No <br />nun DING <br />2-Z 7 2.r"/ <br />i v <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />PLUMBING <br />I <br />225 <br />N1IG L <br />/� �� A r <br />OCCUPANCY <br />NO Of VORIS <br />OCCUPANILOAU <br />BASEMENT <br />MECHANICAL <br />) <br />GROUP <br />U-I <br />2 <br />I <br />OYES ❑NO <br />ADD{ I IONAL PI AN CHECK <br />—'— <br />� <br />.37 `j�f <br />FIRE SPRINKLER REOD <br />ArASON <br />oulEn <br />I <br />FIRE ALARM RED <br />REASON <br />STATE BUII DING SIIncHATIGE <br />f <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />Plml Ir. WonKS <br />' <br />LOCAL SALES-- <br />-/J <br />DATE IV/4 <br />TAX CODE IS 3105 <br />TOTAL <br />F/1 <br />