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MY <br />APPLICATILA FOR C014STRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />I-1 DEMOLITION I I COMBINATION I I BUILDING I I MECHANICAL PLUMBING I I SIGN <br />PROJECT ADDRESS <br />}os sc. Ed�x'� 7T MALE ✓/ay Sv.'7 -,�(p <br />OWNER MAIL ADDRESS CITY '?L?F61PHONE C�'YWVe7' CAC CCJ>C <br />NFb✓q 7-o-lrr4 i Co"? 949 e;lg - n'u)Y �511'T(EpA-i_o3 (o TENANT MAILAUDRy,� <br />ESS CITY LTIP PHONE <br />Ni«iPs_�ar boo /4?egc) 44,i#/a/1EbW, Lyryrvw, uw <br />A C TECT OR DESIGNER MAIL ADDRESS �— CITY 711, PHONE <br />I /VA'lll N/q _ <br />GENERAL LnNTRAC70R MAILADDRESS CITY 71P PHONE SLATE LICENSE <br />/oc r 9 fly/, .s; >LG .S /rS�Od /2/� </Ir A/�'_�•/�c�� J`�D/,' i 1i�,s fiIZOG `/TZ <br />MECHANICAL CONTRALTO AIAILADURFSS CITY 21P PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY 21P PHONE STATE. LICENSE+ <br />CONTRACT PRICE: OF WORN <br />h'22 o G <br />HEATING SYSTEM: I-aAS 1 1 ELECTRIC F1 <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />�/CL /YPANOxirrlr9TL� / E <br />CONTACT PERSON AND PHONE N0. <br />iG�✓ NiGciP= 77 <br />OF Peel Gd gLi- If- ai✓s7;1--Vl Ton/ <br />FLOog is CE/[ i n/l-� <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 01, 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 />///� �/fi-� ///� /f�/ <br />X <br />PROPOSEDFS ;l DrnO �G%%�i[, /eC�T/`t L- <br />T <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH TWOCOPIESI <br />LOT BLOCK OF <br />' <br />PARCEL TAX I.0 NUMBER �, GS ' 7 -owl 3 _pp oj� <br />z r - ._ _ <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />SIGNATURE '' DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C — A/HNDLG UNITS — H.F. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />FIREPLACc INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING <br />i <br />i <br />EXHAUSTFAN <br />— <br />— <br />I <br />--T <br />SUB TOTAL S <br />SUB TOTAL $ <br />------------ <br />PERMIT S <br />I <br />PERMIT 5 <br />TOTAL FEE S <br />TOTAL FEE S <br />rno nccl!`c "Cc r%ml V. <br />IF CNT SETBACK <br />READ SETBACK <br />SIDE SETBACK <br />CHECK NUMBER <br />FEE <br />RECEIPT NO <br />L /DJ <br />_. <br />USE70NE <br />LOTAREn <br />VACANT SIZE <br />jPLAN <br />FEES <br />VALUATION <br />FEE <br />LUING <br />I <br />FI YES Il NO <br />HEIGHT LIMITATION <br />NO OF DWCLLING <br />SIIE OF BLDGR I. <br />' <br />UNITS <br />PLUMBING <br />' <br />MECHANICAL <br />1 <br />OCCUPANCY NO OFSTORIFS <br />OCCUPANT LOAL BASEMENT <br />ROl1P <br />❑VES f NO <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM RED'."— <br />lFA°ON <br />I <br />07HER <br />FIRE SPRINKLER RED D <br />REASON <br />� ' <br />STATE BUILDING SURCHARGE <br />PIIPIIC WORKS <br />TYPE OF CAST <br />PLAN S APPROVE DRY <br />CITY OF EVERETT <br />LOCAL SALES <br />; <br />TAX CODE IS 3105 <br />TOTAL <br />�_ <br />DATE <br />_ <br />