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APPLICATION FOR CONSTRUCTION P1EIT <br />CITY OF EVERETT • BUILDING DIVISION ' <br />3200 CEDAR STREET • " <br />CITY OF <br />EVERETT, WA 98201 •259-8810 Public Worrksks DDLpept. <br />I I DEMOLITION I I COMBINATION I I BuB_rnNc IVIUrl UAIllA1 ,l .,.... <br />PROJECT ADDRESS <br />29�y -�ncDougQ(,4ue.�EvERErrCuHOCES�IL�PRPERJ <br />OWNER MAIL ADDRESS CITY ZIP PIIUNC <br />peferKneh7 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />wn , uLV <br />ZIP PHONE <br />ARCHRCCT OR [WSICNER <br />MAIL ADDRESS <br />CRY <br />711, <br />PIIONF <br />GENERAL CONTRACTOn <br />MAIL AODnESS <br />CITY <br />TIP <br />PHONE <br />STATE LICENSER <br />ME ANICAL CONTRACTOR MAIL ADDRESS <br />fncr gerq¢ion0 Neccffirig;Ill <br />PLUMBING CONTRACTOR <br />CIrY <br />i575Ppgp; au!'lfngio�l <br />-- <br />TIP <br />PHONE / 6 �1 <br />Cel }� 757 <br />3 <br />STATE LICENSE A <br />6505 /�EFRZ2 *�o6[b <br />MAIL ADDRESS <br />C�TT 7 <br />' <br />P2 1 <br />STATE LICENSE A <br />CONTgAGi PRICE OF WORK / <br />Od <br />AL.✓AR <br />HEATING SYSTEM: I GAS %%ELECTRIC fl <br />DE SORIBF. WORK AND DARE FOOTAGE INVOLVED <br />CONTACT PERSON AND P TUNE NO <br />Ins�alla;L L o{ 3 S Ton n I <br />TO►lU FrnS�grri (360) 757 b909 <br />Woof 4o� unl�S oioina <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />`Rq UbLD USE OF BUILDING <br />�y`'�PERTY <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPRON O{'PgOPERTY I$IIOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLocX or <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 1 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 18.27RCW AND 296200 WAC. <br />PARCEL TAX I D. M)MBER <br />_ C, <br />X ItCr�' 913I95- <br />CONSTRUCTION LOAN LADDRESS, TELEPHONE NUMBER <br />$1GNAlUR' OZ ✓ Z -J & DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF F'XTURE OR ITEM <br />FEE <br />WATER CLOSET( TOILE"I) <br />_ <br />;JC—A/HNDLG UNITS—H.P. �/'T OQo 614d <br />�— <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS —B.T.U. M E.A. <br />LAVATORY (WASH EASIN) <br />PEAT PUMP <br />, <br />SHOWER <br />' <br />L-NIT HEATERS — B.T.U. M <br />KITCF:EN SINK & DISF <br />; <br />CLOTHES DRYERS <br />' <br />DISHWASHER4ENTILATIO14 <br />FAN <br />, <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />N'ATER HEATER <br />, <br />URINAL <br />; <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />_ <br />FIREPLACE .NSERT (WOOD BURNING) <br />BACKFLOW PREVENTE <br />; <br />GAS FIREPLACE <br />S;NK (SERVICE — 80,9,F.IC.) <br />_ <br />GAS RANGE <br />_ <br />GAS PIPING <br />EXHAUST FAN <br />, <br />, <br />_ <br />SUB TOTIIL $ <br />SUB TOTAL $ <br />' <br />PERMIT_ $ <br />_ $ <br />TOTAL FEE $ <br />' <br />_PERMIT <br />TOTAL FEE $ <br />FVH UFFIGE USE ONLY: <br />FRONT SFTPACI' <br />nFAR SETBACK <br />SIDE SETBACK <br />rIANCIIECK UMBCn <br />FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SOE <br />FEES <br />VALUATION <br />FEE <br />IIVES 11 NO <br />BUILDING <br />' <br />ICJ •11 L'MITATIO'1 <br />NO OF L"WELLIYG <br />SIZE OF BIDG/TI <br />UNITS <br />PUIMDING <br />I <br />OCCUPAIICY <br />NO)1510-,[S <br />OCCUWNT LOAD <br />BASEMENT <br />—�— <br />CROUP <br />MECHANICAL <br />AYES it NO <br />ADDITIONAL PLANCNECK <br />I <br />IInEALAnM REDO <br />nEAS(M! <br />T— <br />OTHER <br />rIPF SPRINKI ER PF.OT <br />f.FASON <br />STATE BULL DING SUIRCUARGE <br />I - <br />' <br />CITY OF EVERETT <br />TYPE of ronsr <br />PUBI.Ic NonKs <br />I <br />LOCAL SALES <br />TOTAL <br />— ----- <br />UATL TAX CODE IS 3105 <br />