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APPLICATI4� FOR CONSTRlJC1.ON PERMIT <br />GITY OF EVEPETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f 1 DEMOLITION f I COMBINATION � BUILDING I i MFCHANICAL Il PLUMBING f� SIGN <br />PROJECTADDRESS `�,JZ -� J�O�KCF�C.LCi: NdC , <br />owr+cn M�ILA�DRESS , / cin zir rr�or+e <br />�l�il �Sl1L_� n�T?/cA U�/.li/�.S <br />7[N�NT MNLAD�RESS CIIY IIP FHUNE <br />4RGNRECTORDESIGNER MAILAD�RE55 GIIY 71P PHONG <br />L'f///-� [:^l�lC� <br />GENERALCONTFlACIOR NNLAD�RGS$ �ITY 71P PMONE STAiELICCNSE" <br />A1�caY c•'cr�sT.u<T/c:J /�{31i .:1�r Rdc. n�,w. ic;suc 9�Z7/ Gsi-SGo� MacoY�-v7�D�a <br />MECHANICRLCONTfi4CTOR MAILAO[1RE55 CIN ZIP PHONE STA7E�ICENSE+ <br />PLUMBINGCONiR�CTOR MAILAODPE55 CITV ZiP PMONE STAtELiCENSFr <br />CONTRACT?RICE OF WOPK u .= <br />/ 7��� . <br />DESCRIBE WOHN AND SOUARE FOOTAGE INVOLVED <br />� <br />HEATING SYSTEM: f� GAS rl ELECTRIC ; <br />CONTACT PFRSON ANO PHONE NO. <br />/I7/KE /NALnY ' �c"�2 -Si <br />I HEREBY CERTIFY TFIAT I HAVF READ AND EX4MINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />aaoroseo use oF eui�oiNc , PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />� S� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEGALUFSCR�PTIONOFPROPER"Y�SHOWHBELOWORNTACNTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />�or BLOCN or AUTHORITY TO VIOLATF OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL lAW REGULATIIJG 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 COMPLY WI � H THE STATE <br />PARCELTqX ID. NUI,ABER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />r <br />CONSiRUCTION LOAN LENOEfi. qDD{iE55. TELEPIIONE NUMf1ER - �� h �'.��Q - j S <br />X <br />SIGNATURE � OATE <br />PLUMBING <br />NO. TVPE OF <br />WATER CLOSET � <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRY TfiAV <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — BAR, <br />FOH OFFICE USE ONLY: <br />FRONTSEi�ACK REM SET�ACK <br />USGZONE ILOiAREA <br />ITEM <br />CITV OUSINESS LICENSE NO. <br />FEE NO. TYPE OF FIXTIIRE OR ITEM <br />� 4/C —AMNDLG UNITS — H.P. <br />� FURCEDAIRSYSTEMS—B.T.U. M E.A. <br />T HEAT PUMP <br />--'— — <br />! UNIT HEATERS — B.T.U. M <br />SUB TOTAL S � <br />PERMIT S i <br />TOTALFEE 3 � <br />SIDE SET�ACK PLAN <br />IIEIGIIiLIMIT�TION NOOFOWEIIJNG <br />UNITS <br />OCQIPANCY NO OF Si0RIE5 OCCUP�NT LOAD <br />GROl.�3 Z �i . <br />� <br />FIFiEALAqMREO'D RE�SON <br />FIRE SPRINKI ER REO'� RE�SON <br />�C�� <br />VACPNT SITE <br />IIYES f� NO <br />SIZE OF CIUGRI <br />LiASEMEN7 � <br />Cl VES Vf ND <br />CITY OF EVERETT <br />IOCALSALES <br />TAX CODE IS 3105 <br />AUILOIN3 <br />VENTILATION FAN <br />RANGEHUOD <br />WATtR HEATER <br />WOOC STOVE <br />METAL FIREPLACE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGF <br />GAS PIPINC <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE 5 <br />F[E RECEIPiNO. <br />' J <br />VALUATION I <br />•`�'�(�'% <br />PWMpING <br />MECNANICAL <br />ADDIPONhI P:AN CHEGK <br />OiHER <br />STAiH OUI��ING SURQIARG[ <br />ruoi ic wonres <br />TOTAL <br />FEE <br />