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APPLICATIO.1 FOR CONSTRUCT►jN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />32DO CEDAR STREET • EVERETT. WA 98201 K 259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING I ❑ MECHANICAL �}' PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �X XC KeLy)(5 I ue: ,\ <br />-) 3/ <br />OWNER MMLADDRESS CITY lip 11IIONC <br />�9��c� ZnE-3'f�-c1��/� <br />TENANT MAIL ADDRESS CITY /II- PHONE <br />NE <br />SIGNER MAR ADDRESS CITY III, rBGrvi <br />;,W. 7 .Ne �l 8v7�sT /ncrl,/ � 9Bz7s �6-7scs-�s69 3 �zy <br />-+——�--�— 'If --- O LATE LICENSE <br />GENERAL CONTRACTOR MAI'L;;��RESS OILY . PHONE 7_ 6- <br />S <br />%?206 -33PY?l!;- 5l��coE>f�o�Kz <br />MECHANICAL CONTRACTOR MAIL ADDRESS , CITY fir PHONE STATE LICENSER <br />PIUMBPJGG TRACTOR MAIL ADDRESS Cltt / ft 7�1i' PHONE STATE LICENSE) <br />A // 1 A/7 �_ .i A.. .. /._nn.v i%/i /)::...L ,f'ilr:'.4 //%Il(;�1 '�- Jn:.-742.-C_�F_.L}A r%�Jt.^'TFF�%r%['n%RJ %2 <br />/uw f rTe7r/IfI'-(InA rf <br />9-- <br />CONFIACTPRICEOF WORK <br />HEATING SYSTEM: C] GAS ELECTRIC ElrI5 <br />OOU <br />DESCRIBE WORK AND SQUARE <br />OfEI!V <br />FOO/r?�'G Q:r.r�. <br />fT PER:O�/D <br />�/y, l'�� S• 7Q�4 L/O( %S4S <br />z �l �- <br />q <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Cam' <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />OR <br />PROPOSE&USE OF BUILO)y <br />/�/ <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />THE PROVISION OF ANY <br />LEGAL DE RIPTION OF PROPERTY I WN BE LOW OR ATTACH C9�ES) <br />LOT' )Q� %`Y�pp�a-� OF � y �Qr,C/ `.O, <br />�-�'£•7G <br />AUTHORITY TO VIOLATE OR CANCEL <br />OR THE <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />/ <br />,S Z I ly U �) tlE.IS cL - rtGOY'T E'C <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 18.27 RCW AND 296.200 WAC. <br />SC• <br />OFF;A01ViH/SI <br />PARCEL TAX S/I 0.0.*UMBER <br />yJp p. <br />CONSTRlIC110N LO.A/N LEWEER. ADDRESS. TELEPHONE NUMBER <br />Ly/fiflV�Lf �A/orI"�p.c clox ` JOJ 7 'h <br />X <br />SIGNATURE. DATE <br />✓t r 'J�//��f.�kc ,'�rrAcc�(.�RP�Y3 �Zne -'� / �J' �Jb L� <br />f.ITY BUF'NESS LICENSF. ND <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TIPS OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C —AfHNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />' <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 6 DISP <br />i <br />CLOTHES DRYEr,r• <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />) <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />�— <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />GAS FIREPLA-E <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />i <br />EXHAUSTFAN <br />M <br />SUB TOTAL S <br />PERMIT S <br />I <br />TOTALFEE S <br />' <br />n/ <br />FVM urriuC VAC vim—: <br />LO • p•, <br />fEE <br />RECFIPT NO <br />FRONT SETBACK <br />REAR SETBACK SIDE SETBACK <br />PIANCIIECKNUMDFn <br />20 <br />.7 <br />USE ZO////NffffE <br />Lol AREA VA ANY SITE <br />�PES ❑NO <br />FEES <br />VALUATION <br />FEET_ <br />nU11DING--_..&a. (� <br />-i <br />HEIGHT LIM TATION <br />l <br />NO OF DWELLING SIZE OF BLDGRI <br />UNITS 13Z9 S,F, <br />CmAc 4- <br />PLUMBING(Y-J <br />�=1� <br />I co <br />—F— <br />G <br />Ati E <br />MFCIIANICM <br />I <br />— UI 0�• <br />OCCUPANCY <br />GROUP <br />I NO Of SIORES <br />OCCUPANT LOAD BASEMENT <br />2 <br />I]YES D <br />-/ <br />2-IL---I <br />ADDIIIONAI. PIANCIIf CK <br />' <br />FIRES INKLER RED 'D <br />fIFASON <br />— <br />�— <br />I <br />onlEn <br />I <br />FIRE ALARM REO'D <br />REASON <br />STATE BUILDING SIInIa UnGE <br />(,jV <br />f•Ilpl If. WOfiKS <br />r <br />' Q� <br />TYPE OF f,ONSi <br />PLANS APPFOVEO By <br />CITY OF EVERETT <br />LOCAL SALES <br />S <br />•� <br />2 —/A/ <br />DALE 1p 6 <br />TAX CODE IS 3106 <br />TOTAL <br />_ <br />