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APPLICATA FOR CONSTRUC*N PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET P EVERETT, WA 98201 E257-Ml0 <br />7 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL IN PLUMBBR7 ❑ SIGN <br />PROJECT ADDRESS <br />ago T lr�_In AJG <br />DWNEa Ij MAIL ADDRESS CITY Z► ANIONS <br />Dr' 1•. .�AAi.w�i <br />TEwNT uut AooREss alv <br />AACMIECT M DCSKINLR MAIL AwM1ESS CITY ZIIA FMONE <br />GENERAL CONTRACTOR MAR.AP'n1E55 CITY ZE' ALOE STATE LICENSEE <br />MECHANICµ CONTRACTOR MAIL ADORE SS CITY ZP "NONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADORLSS CITY /� ��71 m P,I STATE LICENSE <br />CONTRACT PRCCOF WORK Cy .-%rO kSa <br />HEATING SYSTEM: ❑GAS Il ELECTRIC f_l <br />CESCRIRE WORK AW SOOTHE FOOTAGE IM'OL\EO <br />/G`��` <br />CONTACT PERSON AND FACNIE NO <br />J <br />A <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 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO "IOLATE OR CA ICEL THE PROVISION OF ANY <br />OTHER STATE OR LOW.. LAW REGUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CG,NSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PR' IPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS IIADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW '9.27 RCW AND 296.200 WAC. <br />X <br />PROPOSED USE CA BUILDING. <br />LEGAL DESCRIPTION OF PRDPERFY ISNOWN BELOW OR ATTACH TWO COI <br />LOT BLCFK a <br />PARCEL TAA 10 NGAIREA <br />CONSTRUCTIONLOANLEN R. ABORESS. IFLCPIICNE MRIBER <br />SIGNATURE DATE <br />wTY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILETI <br />AC — AHNDLC UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />so <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />AGAS <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNINGI <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTALFEE S <br />TOTALFEE S <br />FOR OFFICE 11SF ONLY[ lI r)rnDd'1n <br />L RONT SE IIMCr: <br />REAR SETWX <br />SIM SE TBACK <br />PLAN CHECK 70 <br />FEE <br />RECF.PI NO <br />USE ZONE <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BunwlA; <br />OYES M NO <br />HEIGHTLIMITAION <br />NO OFOWEILING <br />SUEIWiI CI <br />WIS <br />PLDMBIND <br />Upµ1CY <br />N]CI SRIR(5 <br />OCCUPANT LOAD <br />PASEN[Nt <br />MECNANCµ <br />DYES ❑ NO <br />MOITIONAL PLAN CHECK <br />FOE SPRINALCR NEC D <br />REASON <br />OTHER <br />FOEAURMREOD <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST <br />PL ANS APPROHn L_+ <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />MIL <br />TAX CODE IS 3105 <br />TOTAL <br />