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y <br />9 <br />APPL.ICATI*.PN FOR CONSTRUC h iON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL 41PLUMBING ❑ SIGN <br />PROJECT ADDRESS: / %-10 U/r j / w/Fi <br />BchArd 11'�. I'),zo—y/AqIA4A Er-ETr L07- cJF.zol d 5k-�1f%6r% <br />MAIL ADORE. SS C17Y ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />-� I rn{ <br />GENERALCON4U Cn <br />MAIL Awn[ss <br />__ <br />CITY <br />)IP <br />PHONE <br />STATE LICENSE • <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE UCINSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />5TAT E LICE NSEY <br />CONTRACT PRICE OF WORK 94- 0 (� <br />�OO) — <br />HEATING SYSTEM: *-GAS ❑ ELECTRIC ❑ <br />DESCRIBE ORK ANO $OITARE FOOTAGE INVOLVED <br />_ 4L — is711 ebteOo/vt <br />Iw7c�chR�d. <br />CON IAII UN AND PHONE NO <br />/y/AS% �66-�3�6 <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAT ION AND KNOW THE SAME TO BE TRUZ AND CORRECT ALL <br />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 :OR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONS 16.27 RCW AND 296.200 WAG. J <br />X <br />PROPos[o USE of BUILDINGPROVISIGNS <br />Soh LQm/�' t� <br />R <br />LEGAL DESCRIPTION OF RTr(SHOWN /BELOW OTA ATTACH TWO COPIES) <br />.LOT N I/. ia�r z �, `/ or U. <br />r <br />PARCEL TAX I p NUMBER <br />CONSTRUCDON LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />SIGNAT E DATE <br />CILY flUSMEss UCENSC NO <br />PLUMBING <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— <br />BATHTUB ,(, ST{pwr _ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />�— <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />_ <br />METAL FIREPLACE (WOOD BURNING) <br />T ; <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN DRAIN <br />GAS FIREPLACE <br />BACKFLOW "REVFNTERS <br />GAS RANGE <br />_ <br />SINY. (SERVI-E — BAR. ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />i <br />SUB TO —TALE <br />F <br />pJ <br />SUB TOT�.L E_ <br />�— <br />__ PERMIT $ <br />PERMIT E <br />TOTALFEE E <br />I <br />TOTALFEE E <br />FOR OFFICE USE ONLY: I <br />FRONT SF TRACK <br />READ sFIBACK <br />SIDE SETBACK <br />PLAN CHECK mum`n <br />F r rYl <br />(VALUATION <br />nFCTIPT NO <br />USE ZONE <br />IUI AREA <br />VACANISHE <br />OYES LT NO <br />FEES <br />FEE <br />n111IDMf. <br />HEIGHT LIMITATION <br />NO TT DWELLING <br />IINIL$ <br />SIZE Or BLDGRI <br />O ,J, <br />PI IIMBINf. <br />�T d <br />O <br />OCCUPANCY <br />GROUP <br />-'S <br />NJ M SIMLLS <br />IJ I` <br />OCCUPANT LOAD <br />A) A <br />BASEMENT <br />❑YES ❑NO <br />_ <br />MECHANICAL <br />ADDITIONAL PUN f`IECK <br />-- <br />� <br />;36" <br />FIRE SPgIIZKLER REO'D <br />0 <br />_ <br />nFASoN <br />Ouren <br />FIRE ALARM RED <br />/ f IT <br />REASON <br />STATE BUILDING suncHAFIGE <br />TYPE OF CONST <br />PLANSAPP vEDBY <br />�i A <br />DATE / 1 - /) - 9 ( <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />N <br />Pnnc wonKS <br />' <br />TOTAL_ <br />---'— <br />I 139 <br />