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: . i ' . . . .. � . .._ . r ; . ,..•,. �.::.. � � ' f a /.t\ .L <br /> � . ,j <br /> APPLICATION FOR CONSTRU�:TION <br /> PERMIT ; <br /> fhe Everyroen - everet[ <br /> CITY OF <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•e810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> JWryER MML�DDPESS GIiY 21P PMONE ' <br /> Bill Duesenberg/D&D Investments 9 Lake Bellevue Dr Bellevue NA 9II005 454-3993 +! <br /> TENANT M�ILA�ORESS CITY ZIP PNONE I <br /> Snohomish Family Counseling (c/o contractor) Everett WA 9820� 348-5989 + <br /> ARCHITEGTONOESIONEH MAIL�O�RESS CITY 21P PMONE � <br /> Ned Nelson Arc.hitect 3 Lake Bellevue Drive #200 Bellevue {4A 98005 455-4900 � <br /> GENERALCONTR�CTOR MAIL�OORE55 CITY ZIP P110NE LIGENSEe <br /> Cobra Construction P.O. Box 1299 Everett NA 9II206 258-36G7 CO-BRAC-C240BZ i <br /> A1ECH�NIG�ICONTH�CTOR M�IL�D�RE55 GRY 21P PHONE LICENSE• � �, <br /> PLUMBINOGONTR�CTOR MAIL��ONE55 d�Y 21P PHONE 4CENSE• � <br /> GUSS OF WOPK 1 <br /> ❑ NEW ❑ ADOITION m ALTERATION � tiEPAIR ❑ DEMOLI710N ❑ WOODSTOVE/FRPLINSEFT ❑ BUILDINOFELOCATION li <br /> TENANT IMPROVEMENTOP INTEflIOR REMODEL ONLY CANT�Gi PERSON ANO PIIONE N0. i <br /> CONTMCTPRtCFOFWCRK: $27,500 Ned Nelson , Architect 455-4900 �� <br /> ' G'_9CRIBEWOXK�NOSOU�REFOOUGEINVOLVEU construction Of <br /> interior artition walls & finishes 5 68sf) , <br /> � rnoroceouseoFaw�oiNa IHEREBYCER7IFVTHnTIHAVEREADANDEXAMINEDTHISAPPUCAT10NAND � <br /> o f f 1 c e KNOW THE SAME TO BE TRUE ANO CORRECT.ALL PROVISIONS OF LAWS AND <br /> , LEMLUESCRIPf10NUFPPOPERTY1SHpWN BELOW OR PTf�CH FOURCOPIE51 ORDINANCES GOVERNING THIS 7VPE OF WC�RK WILI BE COMPLETED WITH <br /> . WHETHER SPECIFIED HEREIN OR NOT.THEGRANTINGOFAPERMITDOES NOT <br /> PRESUMETOGIVEAUTHORITYTOVIOLATEORCFNCELTHEPROVISION30F . <br /> � l0T B�oCK OF ANYOTHERSTATEORLOCALLAWREGULATINCaCONSTRUCT10NORTHEPER• ! <br /> FORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> ' see attnchecl THISPROPERNTOPERFORMTHcWORKFOHWHICHAPPLICATIONISMADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCVJ ANO <br /> 298200WAG ,S.aO eW�N� <br /> ' SIGNATUREOPCONTR�GTORO AUTNOHREDAGENT D�TE g���q�� �. <br /> ��9� 4�-� �/�� ,; <br /> PRQIECf�DORE55 � i� <br /> APPLICANTSCI 8 SL SENO. BUSINESSN�ME <br /> � <br /> 111 S.E. Everett lfall 1Va Everett � <br /> PLUMlINO MECHIINICAL I� <br /> � NO. T/PE OF FIXTURE OA�TEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATERCLOSET(TOILEp A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA ' <br /> LAVATORVIWASHBASIN) UNITHEATERS—BS.U. M ; <br /> SHOWER CLOTHESDRYERS _ ' <br /> KITCHEN SINK 6 DISP. VENTILAT�ON FAN ' <br /> DISHWASHER RANGE HOOD - <br /> LAUNDRYTRAV WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE d CHIMNEV , <br /> DRINKINQ FOUNTAIN FIPEPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN � <br /> -- � <br /> SINK�SERVICE—BAR,ETC I <br /> _— � <br /> SUBTOTAL S SUBTOTAL 5 _ <br /> PERMIT E PEfiMIT 5 . <br /> TOTAL FEE $ TOTAL FEE 5 �'i <br /> FRONTSETBACR PE�PS[f&�CK SIDESEfORL� PIANCNECKNUMBER FEE PECEIPiNO. ' <br /> c� c� 10 9/ � G 7i i76. s�' S� 9 5�5�9 i <br /> lISEZONE IOT�flEA V�C�NTSITE FEES VALUATION FEE <br /> G� I ❑YES Ll NO �' <br /> BUILDING a, Soo <br /> ttPEOFCANSi, OCCUPANGVOROUP NOAFOWElUN0UN1T5 -) �' <br /> ei�owne��•ctue , pLUM81NG !' <br /> 1' <br /> SI OF B100. NO.OF STORIES BSMT. OGG IO�D <br /> ❑v MECHANICAL E� <br /> 57z0 SQ.xj� Z N 81 F, <br /> NEIGMTLIMITQI0IL OTHER <br /> ,` / i <br /> FIRE9PRINNLER9REOUIpED ❑YES 'J�NO "� STATE BUIL�ING SURCHARGE <br /> < <br /> STATE ENERGY SURCHARGE I <br /> �PPLICATION�CG Ol' PUNS PR.BY � <br /> � PUBLIC WORKS � <br /> TOTAL ` <br /> . ^"��R <br />