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APPLICATICA FOR COPISTRUCAWN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />Fl DEMOLITION C 1 COMBINATION i I BUILDING 1-1 MECHANICAL I 1 PLUMBING SIGN <br />PROJECT ADDRESS 305- SC. E✓ tfifrr Mar, wA� <br />/ VIAIL ADDRESS n /CIrY 21P PRONE n <br />f f� �rti�J°n� l r Q?D`7 ({�ar-caa hfwti //c tro,r O�i 1nA <br />CRY '/ / ZIP PHONE <br />BQooKLy� f t6�C5 3os S.F. E*Iffr M L W E✓b/1Eff gg)_08 2qo- 9195 <br />ARCHITECT On DESIGNER <br />MAR. ADDRESS <br />CITY ZIP <br />PHONE <br />GENEHAL CONTRACIOn <br />An 510i+i AAp <br />MAILADURESS <br />LESS v6ozmf P✓E �✓ <br />CITY ZIP <br />04fl4f <br />PHONL <br />STATE LICCNSF� <br />98l 01 <br />2024700 <br />/✓�/ OScS3SpZ <br />MECHANICAL CONIRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />p110NG <br />STATE LICENSE• <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK a <br />y� 9 -O — <br />HEATING SYSTEM: 11 GAS 11 ELECTRIC 11 <br />DESCRIBE WORK AND SQUARE fGOTAGC INVOLVED <br />CONTACT PERSON AND PHONE NO <br />Z82-07a0 <br />lor4l,L 7C7(E ILlHMr�lEO ow <br />i <br />Sib✓ <br />01J"_s Q Bfll-PI6 <br />I HEREBY <br />CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROPOSED USE OF fl111LDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN ORNOT. <br />LEGAL DESCRIPTION CF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK of <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 MAV AND I COMPLY WITH THE STATE <br />CONTRACT S LAW .27 RCW AND 296.200 WAC. <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION L DAN LENDER. ADDRESS, TELEPHONE NUMBER <br />X �� <br />SIGNATUR DATE <br />CITY BUSINESS LICENSE O <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —A/HNDLG UNITS —H.P. <br />I <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />VENTILATION FAN <br />, <br />LAUNDRY TRAY <br />' <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />, <br />WATER HEATER <br />, <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />)— <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />�— <br />_ <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT 5 <br />, <br />PERMIT S <br />TOTAL FEE S I <br />_ <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FnONT SFTOACK <br />REAR SFTBACK <br />SIDE SETBACK <br />PI AN CHECK NUMBER <br />FPE / <br />nFCFIPT NO. <br />of a� <br />4a <br />USE 20NF F'� <br />I OT AnFA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />_r — I, r�- <br />— <br />'IYES No <br />nDILDING <br />H LIMITATION <br />NO OF DWELLING <br />S1ZE OF BLDGRI <br />PLUMBING <br />�„ <br />Cr� <br />UNITS <br />OCCUPANCY <br />NO OFSTORTS <br />OCCUPANT LOAD <br />BASEMENT <br />--i- <br />CHOUP <br />MFC14ANICAL <br />, <br />, <br />f IYES II NO <br />ADDITIONAL PLAN CHECK <br />- <br />) <br />FlRE ALARM nEOD <br />nFA50Y <br />OTHER <br />' <br />FInFSPBINKIF.RREOD <br />RFAFON <br />STATE BIRI DING SURCHARGE <br />TYPE OF CONST <br />PI ANS MP 1 Tiny <br />CITY OF EVERETT <br />Punuc wonKs <br />LOCAL SALES <br />-;— <br />TOTAL <br />; <br />OAIE i , °j J <br />TAX CODE IS 3105 <br />