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i-,- 3- i j <br />APPLICATI(o d FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 • 259-8810 00L <br />F) DEMOLITION 11 COMBINATION BUILDING I 1 MECHANICAL I ' PLUMBING i I SIGN <br />PROJECT ADDRESS <br />1� <br />crry T'!I�, " ZIP PHONE <br />�s n A cP IoC�S �cLL -b6 of L�TE� �z�Z 2 <br />TENANT Mt ADDRE SS CITY I ZIP PHONE <br />I.nIH-CI oOR DESIGNER MAR ADDRESS CITY <br />�L LA A q a L Lm 19 2-i 3 K 6 (a� e <br />GENERAL CONTRACTOR MAIL AOUnFSs I, <br />A-mPAr1 ccu,j CLM <br />shrl�r�, Ev <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY <br />PLUMBING CONTRACTOR MAIL ADDRESS !,'ITY <br />CONTRACT PRICE OF WORK -� <br />A/" /T77� i1 <br />1i1 PIIUNG STATE LICENSEI, <br />&ZP <br />IP PHONE STATE LICENSE <br />ZIP PHONE STATE LICENSE <br />HEATING SYSTFM- I l GAS -I FI FCTRIC rl <br />RIB. WORK ANp -SQUARE FCKITAfiE Iry`y0;t1VED i� 1 <br />IAA I.i a VJCl Y Y <br />CONTACT PERSONAND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED T41S <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 COMP WITH THE STATE <br />ORS LAW RCW AND 2 M AC. <br />X <br />5"'Rr <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SIIOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK or <br />/� <br />{�lt—lY`+1y7 c t-cl <br />PARCEL TA%1,,,D,�,�UMBER <br />�ESa7- 000 -o ` - D00�I <br />C STRUC710N L ANQLE�ILI�R. ADORE,SS. TF.LEPHO NUMBS <br />C <br />sk'v DATE It <br />2-97- 95 <br />CRY BUSINESS LICENSE NO <br />PLUMBING I <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS—H.P. <br />�— <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />—; <br />SHOWER <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />-�— <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING <br />_ <br />EXHAUST FAN <br />i <br />I <br />_ <br />I <br />I <br />�— <br />SUB TOTAL <br />S <br />SUB TOTAL S <br />PERMIT <br />S <br />i — <br />PERMIT $ <br />TOTAL FEE <br />S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SFTSACK <br />RE An SETBACK <br />SIDE SETBACK <br />PLAN CAEC NUMRF.R <br />FFI <br />RECEIPT NO <br />0 <br />USE ZONE <br />IOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />$QI DIJJ <br />/fT <br />90 I OD <br />I IYES i' NU <br />))EIGHT LIMITATION <br />NO 01 UWLLLING <br />517E OF BLIEAI <br />PLUMBING <br />- <br />i <br />I <br />UNITS <br />A <br />N ZI <br />OCCUPANCY <br />NO Of STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />NICAL <br />MECHANICAL <br />I <br />GRUI5/1 <br />ry <br />I <br />A/ n <br />1 <br />ADDITIONAL PLAN CHECK <br />— <br />— <br />I <br />V" "1 <br />fIYEB 11 NO <br />FIRE ALARM RED 0 <br />nFASON <br />OTHER <br />FIRE. SPRINKI UP APO <br />REASON <br />STATE BUILDING SURCHARGEI <br />Jr-D <br />TYPE OF C-ONST <br />PI ANS PPPOVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />/7i/ (41 LL <br />M <br />LOCA_ SALES <br />---�L— <br />'1 1 - `t j <br />TAX CODE IS 3105 <br />TOTAL <br />DA E <br />