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APPLICATIGA FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />tFDEMOLITION [j COMBINATION I�] BUILDING ❑ MECHANICAL ❑ PLUMBING �1 SIGN <br />OJECT ADDRESS: ( - �leuC \ IGG� r� £LL=]C� P7�1�\g <br />Inc <br />OWNFR MAIL ADDRESS CITY ZIP PHONE <br />�����5--c'_ t5 L a _- CAN06 <br />TENANT )MAII. ADDRESS V CITY 1]IPA PHONE <br />..I. 1 T _ _.� .. I I I• CY 1 .. 1- I !1 .T .. _ r I A 1 I. .... r A A A -A. ... <br />ARCHEI\MTEdICCTOOR DEANSCITGON�ERv' 1.wM�AI5I AD f o CITY �E IP PHONE L_ Q <br />14C a313- 9S1s8 <br />R MAIL AD�ESS CITY PRONE ATCL Ms�t%�T <br />�rYS&L2DsCa MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE I, <br />_--423�— <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />41s., c9e)0 <br />CONTRACT PR E OF WORK --II <br />-�Zc r•lo{�e o 4L]t �7. T� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />OEBCgIBE RK AND SQUARE FOOTAGE INVOLVED ( <br />re F b4fe- — Veto C Y Q ` <br />u C v k � ro r <br />5 <br />CONTACT PERSON AND PlIONE O <br />J Ielin9 Nar�ln_ Jed r C <br />o r o -FR qa 334--89 <br />I At ^� OTC <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 CCNSTRUCTION. 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 />CONTRA ORS LAW 18.27 RCW AND 296.200 WAC. <br />X <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. Nu ER <br />CONSTRUCTION LOAN LONGER. ADDRESS. TELEPHONE NUMBER <br />SIGNATURE LATE <br />1 <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />--� <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />' <br />_ <br />UNIT HEATERS <br />; <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE (WOOD BURNINGi <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNIM.9) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />_ <br />EXHAUSTFAN <br />i <br />L� <br />SUB TOTAL $ <br />�_J <br />SUB TOTAL S <br />_ <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />' <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEF <br />RECEIPT NO <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />❑YES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDG,TI <br />UNITS <br />�0 <br />PLUMBING <br />' <br />T <br />OCCUPANCY <br />W Of STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />' <br />GROUP <br />�0 <br />❑YES NO <br />_ <br />ADDITIONAL PLAN CHECK <br />FIR SPRINKLER REGO <br />RFASON <br />DNIPR <br />FIRE ALARM REDO <br />REASON <br />STATE BUILUING SI)RCIIARGF <br />— <br />PIIRI IC WORKS <br />— <br />r3Y <br />--__�— <br />TYPE OF CONST <br />PLANSAPP QJFD BY CITY OF EVERETT <br />' / <br />'/,An LOCAL SALES <br />----------- <br />_ <br />V /V .. <br />Da.�U-l6-`��_ TAX CODE 15 1105 <br />TOTAL <br />------ <br />�7IJ.`0_.v <br />