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I <br />I ��fiTFP _•'� <br />APPLICATIOA FOR CONSTRUCTvON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />f-1 DEMOLITION (1 COMBINATION BUILDING >t,MECHANICAL PLUMBING Fl SIGN <br />PROJECT,j104crlD. - y Jn� I�O } TfR. ^r c--rOWNER t <br />Mi►'JADORESHONE <br />Z CS 1 .� 7a� (�PS�(�OW A`I Av6 IP PS a" �Drr;1 a'7 <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: >XGAs C7 ELECTRIC fl <br />DESC�RI/BTE/WOCRK AND SQUARE �ATpOEINVOLVE ,I.� <br />L/7(pv� <br />CO CT PERSON AtIp RHO(!O.Ow <br />LJUU`` <br />VVIY` <br />'f 7 G��� <br />1 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 />PROPOSEDUSEOF BU L N) <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEG: C PT NOF PROPERTY (SHOWN BELOW CHTWO w1 <br />OR ATTABLOCK <br />of <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR.THE <br />_ <br />46C-147w, ofib OR lJ <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />-OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />X, <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />(((\\\'''''����j��1 //fit //(I/'� <br />X �1J tA,,, •� <br />PAE>L �D.�J1 jL.19ER„) <br />C/LOAN JYLENDER. <br />TELEPHONE NUMBER <br />CONSTRUCTION ADDRESS, <br />yL-yJ <br />SIGNATURE L / DATE <br />CITY BUSINESS LICENSE NO. <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 />' <br />A/C —A/HNDLG UNITS —H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />' <br />SHOWER <br />1 <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />_ <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAU14DRY TRAY <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />i <br />SINK (SERVICE — DAR, ETC.) <br />I <br />GAS RANGE <br />' <br />GAS PIPING <br />EXHAUSTFAN ZI' <br />I <br />' <br />7 <br />SUB TOTAL $ <br />) <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICEyE USE ONLY, yf/ ,'(p <br />FRONT SFTR�CR / <br />REAR SETBAC_ K _ / <br />SIDE SETBA6K / <br />PLAN CHECK NUMBER <br />(/DFEEES <br />FEF, ' / <br />RECEIPT NO. <br />USE ZONEL~,�//� <br />_12 <br />HEIGHT�I�IMg10y <br />���'C4VV/(LUNI <br />LOTAREAI�iC//J VACANT SITE <br />FIVES Fl NO <br />NO. OF DWELLING SIZE OF BLOGBFI <br />(C/ s�f. 2Jr/✓4 + <br />4� <br />BUILDING <br />VALUATION <br />FEE <br />3a2 <br />PLUMBING <br />' <br />'QV <br />OCCUPANCY <br />GROUP <br />NO OF STORIES <br />2 <br />OCCUPANTLOAD BASEMENT <br />IT YES O <br />MECHANICAL <br />Q i QQ <br />ADDITIONAL PLAN CHECK <br />;g7 <br />FIRE ALARM RED <br />REASON <br />FIRE SPRINIY.ER RED <br />REASON <br />TYPE 7 CCO'NST <br />PLANS AI <br />V �LI <br />DATE <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL _ <br />