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A 2PLICATKA FOR CONSTRUC•h dON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259.8810 <br />1-1 DEMOLITION 11 COMBINATION BUILDING 1-1 MECHANICAL f l PLUMBING F 1 SIGN <br />PROJECT ADDRESS <br />lG4LA,%fb n446 a*t-er-TT FsZo <br />OWNER MAIL ADDRESS CITY 7IP PHONE <br />S K 1 tf+ sA..L .3 Avepw'c <br />TENANT <br />MAIL ADDRERS <br />City ZIP <br />PHONE <br />T <br />ARCHITECT OR DESIGNER <br />MAILADDRESS <br />CITY "IF, <br />PHONE <br />M•A <br />GENERAL CON TRACTOR <br />MAILAD RESS <br />CITY 71P <br />&o6s.16524 <br />PHONE <br />TATE LICENSE N7p#jr4 <br />oweJ <br />sr � <br />Nh/� 2 9 �rnww� <br />Okg� <br />74$4SW C F4yT <br />MECHANICAL COI RACTOR <br />MAIL AD',RESS <br />CITY IP <br />PHONE <br />STATE LICENSE/ <br />PLUMBING CONTRACTOR FAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />N/A. / <br />CONTRAIl <br />WORK <br />OF11 <br />. <br />HEATING SYS Fl GAS f-1 ELECTRIC n <br />DESCRIBE RK AND SQUARE I DOTAGE INVOLVED <br />jr A- PerplLp�D 6 <br />CONTACT PERSON AN PHONE 0 <br />�s <br />I <br />G �a Srr " -� Co J a <br />2cs6 <br />I HEqEBY 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 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 />C ACTORS LAW 78.27 RR W�200 WAC. <br />IZ <br />� 9 9 <br />PROPOSED U OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTVISHOWN BELOW ORATTA HT OCO IESI <br />LOT Z/W_ eLocK 9 7 OF! t� 0 Q'vY. <br />PARCEL TAK ID. Nl1MBER <br />SG32- 3q� - 025- 000b <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />5 NAT E DATE <br />CITV USINESS LICENSE NO. <br />PL UMBINO <br />WHANICAL <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 - AMNDLG UNITS - H.P. <br />T— <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />1 <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRYTRAY <br />.� ; <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />.1�1. ' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />_ <br />BACKFLOW PREVENTERS <br />i <br />GAS FIREPLACE <br />SINK (SERVICE -BAR. ETC.) <br />GAS RANGE <br />' <br />GAS PIPING <br />' <br />EXHAUSTFAN <br />� <br />I <br />� <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />; <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />1' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK / <br />REAR SETBACK ' <br />SIDE SETBACK _ / <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZR <br />a <br />LOT AREA <br />VAC NT SITE <br />FEES <br />VALUATION <br />FEE <br />AYES Fl NO <br />BUILDING <br />q � <br />1 <br />I Cgo <br />HEIGHT LIMITATI N / <br />NO. OF DWELLING <br />UNITS <br />SIZE OF B DGal <br />T- lWAM <br />PLUMBING <br />I <br />i <br />RCUPANCY <br />NO OF STORIES <br />OCCUPANT <br />BASEMENT <br />MECHANICAL <br />Ut <br />(LOAD <br />I� <br />YES DCNO <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM REO'D <br />REASON <br />Q <br />OTHER <br />I <br />FIFE SPRINKLER REDO <br />REASON <br />I — <br />STATE BUILDING SURCHARGE <br />IJi� <br />TYPE OF CONSi. <br />PLANS APPROVED By <br />JM <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />DATE 1 7y <br />TAX CODE IS 3105 <br />TOTAL <br />