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APPLlCAT11..� FOR CONSTRUCI �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br /> f� DEMOLITION fl COMBINATION ,t�BUILDINr, (1 MECHANICAL f� PLUMBING �l SIGN <br /> PROJECT ADDRESS <br /> , S� EV CT �.L ��E - d1,1h4(� �'�4ZA • <br /> OWNER MAILPDDtiE55 CITv 21P PNONE <br /> EvGD�IZ ��1L`ti-iC (�c`�A ��Um cc 3g�'� s�-t- ?�c,w�� ,,�1�4 �tScx7(o - <br /> TENANT MAILAOOIiE�S CITY ZP PIIONE <br /> i�('(> 1203 SE �,(;��( �1'441-1- 1,�1e-1 �EfEt( t,JA' <br /> ARCHRECTORDESIGNER MAILAODRE55 GITv 7.IP PHONE <br /> �tr f ���{ iU�� I.JFsi�a�.i A�E '��{bl S�An�E 4Jr� b�ti-q9� <br /> GENERALCONTRACTOR MFILAODRESS CIIY ZIP PHONE STATELIGENSE� <br /> 1��1 CP� S�I�TEI'vE� I fo22 �'�+Ec� t�)A-�-1• ��"L�1 Q 1'�11Ct, L�E�1� 33�1��Y7 �KCCJ�T�kC�'1�1q <br /> MECHA ICALCONTRACTOR MAILRD�RE55 CITV ZIP PHONE STATELICENSEM <br /> p`U 1��ONTRACTOR MAILFODRESS Cltt ZIP PNONE STATE LIGENSE x <br /> N +� <br /> CONTPACTPflILEOF WOR�� HEATING SYSTEM: f.l GAS f:l ELECTRIC ❑ <br /> DGSCW9 WO AN� �REFOOTAGEINVO E,�/� GONT�CTPERSONANDPH NENO. ��� ��C <br /> LCC� �Q.IN--(7 �C,LI) �� (�• <br /> 1 '��Ca^.C. Fbc��L` — �' <br /> I HEREf3Y CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> �(��.(��5� QJ..bI. 1 ' APPLICATION AND KNOW THE SAME TO FE T9UE AND CORRECT.ALL <br /> FFOPOSED IISE OF GUIL�IN PROVISIONS OF LAWS ANO ORDINANCES G()VERNING THIS TYPE OF <br /> ��.� WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTYISHOWNBELOWORATfACHTWOCOPIES) NOT. 1'HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BL�K oF AUTHORITY TO VIOLATE OR CANCEL 1'HE PROVISION OF ANY <br /> OTHER STATE OR LOCF.L LAW REGULATIN(3 CONSTRUCTION OR THE <br /> PERfORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWfJER OF THIS PROPERTY TO PERFOR'N THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I CONIPLY WITH THE STATE <br /> CONTRACTORS AW 18.27 RCW AND 6.200 WAC. <br /> PARCEI.TAXI.D.NUMBER \ <br /> iS28-65�1-�1Z- O 5 x��� � - `Zi� 9�( <br /> CONSiRUCPON LOFN LEN�ER.AOGRESS.TELEFlHONE NUMBER OATE <br /> ,n SIfiNATURE <br /> •y� <br /> CITY BUSME55 UCENSE N0. <br /> PLUMBING 1AECHANICAL <br /> Np, TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEIA <br /> FEE <br /> WATER CLOSET(TOILET) <br /> � AIC—NHNDLGUNITS—H.P. ' <br /> � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> BPTHTUB � <br /> � HEAT PUMP � <br /> LAVATORY(WASH BASIN � <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> ' CLOTHES DRYEfiS ' <br /> KITCHEN SINK&DISP � <br /> � VENTILATION FAN � <br /> DISHWASHER � <br /> � RANGEHOOD ' <br /> IAUNDRYTRAY � <br /> CLOTHES WASNER � WATER HEATER ' <br /> � WOOD STOVE � <br /> URINAL ' <br /> - METAL FIREPLACE(WOOD BURNIiVG) � <br /> DRINKING FOUNTAIN � , <br /> -- � FIREPLACE�NSERT(WOOD BURNING) <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> — � GAS PIPIN:� � <br /> — ' EXHAUSTFAN ' <br /> i � <br /> � � <br /> _ i � <br /> � � <br /> — SUB TOTAL S ; SUB TC>TAL S � <br /> — PERMIT S PERMIT S � <br /> � <br /> TOTALFEE 5 ' <br /> TOTALi=EE S ' <br /> FOR OFFICE USE ONLY: Receirrr+o. <br /> FRONT SE7BALK PEAR SETBACH S�OE SETBACK PIAN CHE, NUh ER /� FEE <br /> ���,� �; <br /> FEES VALUATIUN F�E <br /> USE ZONE LOT AREA VFCANT SITE T— <br /> f 7 VE$ ❑ NO pUIL�ING � � <br /> HEIGNT LIMITATION NO OF DWELLING SI2E OF BLDGrt.I. � <br /> UNITS 3Q/'_3 T•I• PLUTA�ING <br /> l9 <br /> i <br /> OCGUPANCY NOOi5T0AlE5 OCCUPANT�OAU BASEMENT ldECf1ANICAL � <br /> GROUP ❑YES .T� NO � <br /> � <br /> 6� ' D7' ADDITIONPL PLAN CNECK � _ <br /> FIRE AIAfiN fiEO'0 REASON <br /> �j�> Uf�+71A1ANG� OTHER �- <br /> FIRESPRINNIEPREO'0 PEASON STATEBUIL�INGSURCHAFGE � � ��1� <br /> tie� c�rNa�uc� r�x�ria�� ���� _ _ <br /> , <br /> TVPEOFCONST. PlANSA�'PROVEOBY CITYOFEVERETT �UPLICWORKS �� <br /> •n"t� 1 (��VI LOCAL SALES �J � ;��� <br /> -�f" DATE �Z (�' TAX CODE IS 3105 TO7AL <br />