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APPLICATIL A FOR CONSTRUCT w0N PERMIT <br />CITY OF ERETT • BUILDING DIVISION <br />3200 CEDAR STREET • ENERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 1 <br />_VAtERIt (;R43 ;1804 G1PUAp /3VC EufKeff aSa 108q <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />SNo XF/e N0,44imed 1vo/s (oqA ?0 6o-A 3993 EunerO 9frao3 <br />TENANN1 IT L MAIL ADDRESS CITY ZIP ^HONE <br />e-Al Qwil <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />fifty 4,,+ <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />MAIL Af%%RE55 <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE F <br />CONTACT PRICE OF WORK <br />/s Qcx,71 <br />HEATING SYSTEM: K-GAS ❑ ELECTRIC ❑ <br />DESCRIE WORK AND SQUARE FOOTAGE INVOLVED <br />L— 40oO M 41wt t'rl ' Q41ia r�r AA.14v <br />/ <br />C.On?.�T PERSON AND PHONE NO <br />Y�}uL V61c LF�P a5�9 66So <br />huill back' IYoo+, &A, edoless SZw %As1,eU <br />;iv" yy4ww <br />1 HEREBY CERTIFY THAT 1 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 SI �CIFIED 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 TYE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X �ii(/Y. l� o r I _ a-' Vow <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARDEL TAX I NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIGN TLRE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBNIQ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />RANGE HOOD <br />M <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />M <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />' <br />SINK (SERVICE —BAR, ETC.) <br />GAS PIPING <br />I <br />EXHAUSTFAN <br />' <br />i <br />M <br />I <br />' <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT $ <br />_ <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUM/nf/n <br />FEF <br />RFCTIPI NO <br />T <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE^/ <br />DYES ❑ No <br />BUK DING <br />l J DOJ <br />/j�T <br />L' '(� <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />PLUMnINC. <br />UNITS <br />11 <br />OCCUPANCY <br />Iq D SIfVXES <br />OCCUPANT LOAD <br />BASEMENT <br />MFCHANICAI. <br />/107 <br />DYES ❑NO <br />ADDI TONAL PL AN CHE CK <br />-- <br />' <br />FIRE SPRINKLER RED'D <br />RFA�ION <br />C$ <br />,fxsry, Z�PrNr <br />—I-- <br />DTIMER <br />FIREAIARI�REO'0 <br />RF Ac <br />�,V`t Ste, NO <br />surz nunowc sunclance <br />TYPE OF CONST <br />Pi ANhApppovcn BY <br />CITY OF EVERETT <br />PHnuc wonKs <br />vj <br />m` <br />LOCAL SALES <br />TOTAL <br />— <br />-- <br />i L� <br />DATE -j c. y <br />TAX CODE IS 3105 <br />