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APPLICATION FOR CONSTRUC'h.ON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: gGAS ❑ELECTRIC ❑ <br />259-8810 <br />Il DEMOLITION LI COMBINATION I J BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br />OWNER WtADDRESS CITY LP PHONE <br />Housing Authority of the city of Everett 1401 Poplar Everett 98201 258-9222 <br />TENANT MALAODRESS CITY ZIP FHDNE <br />ARLURECTOR DESIGNER <br />MALADORESS <br />CITY LP <br />PHONE <br />The Dykeman <br />1602 Hewitt Ave Everett 98201 <br />259-3161 <br />GENEMLCONTRACTOR <br />MALADDNESS <br />CITY ZIP <br />PHONE <br />STATE UCENSE0 <br />CO, Inc. <br />1600 So. <br />Graham St. Seattle 98108 <br />764-0170 <br />YUNSCI*097CD <br />Yun's <br />MEGHANCAL CpI1RAClpi <br />NULADDRESS <br />I GOY ZIP <br />PWNE <br />STATE LCEUSEF <br />.51,11Y A S <br />A,1I3Om <br />PWYDINOLpNTRACiOR <br />MAL ADDRESS <br />I DUTY ZP <br />PHONE <br />STATE LICENSE <br />""I", /1S <br />GLASSOFYAM <br />❑ NEW ❑ ADDITION <br />i I ALTERATION <br />I I REPAIR It DEMOLITION I I WOODSTOVE/FRPL INSERT <br />I I BUILDING RELOCATION <br />CONTRACT PRICE OF WOIM( <br />DONrAtt PERsaNAxD vxnNE xD. <br />MSCfU1W MKANDSDIIAREFOOTAGEWVVWED <br />PROPOSEDUSEDFBurtowG <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 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESIIME TO GIVE <br />AUTHORITY TO VIOLATE OP. CANCEL THE PROVISIONS 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 18.227L7 RU�C`W AND 296 200 WAC. q <br />)kl�j )�-2>7- /Li <br />LEM DESCRIPTION OF PIXWERTY ISIpWN BELOW DR AITAGH FOUR COPIESI <br />LOT_ BLOCK OF <br />'— <br />PROJECT ADDRESB <br />1411 Larch Street <br />scwuRL FIE <br />[IWMRMSSIK.xHM <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—AIHNDLG UNITS —HAP. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />D <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEAOERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />one <br />FOR'OFFICE USE ONLY: <br />Rld?SETBACK <br />BEAR SETIMIX <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />USE ZONE <br />Lot AREA <br />VACMNTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />WF[pFAM1S AlLOH!&f <br />ME gLOHSTALIWL <br />l¢yw4. <br />IYMWKLLN4MKN <br />PLUMBING <br />SNEO.DLDO. <br />NO.O'STORIEB <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PAN CHECK <br />OCCUPANCYLOAD FIRE SPrvINLFRS REDO UEIGIRLNMTATCN <br />SPRINKLER <br />REASONFOISPRINnERS <br />STATE BUILDING SURCHARGE <br />�T <br />WTAM BY <br />PLANSAPPROWDBY CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TCTAL <br />