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��cllj L APPLICATIO.,o FOR CONSTRUCTL iN PERMIT <br />CITY OF EERETT • BUILDING DIVISION <br />L 3200 CEDAR STREET • EVER ETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBIN4TION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: S q i $ — GT2Y <br />-pc� ;FN( — ►yo y io E�iae c 7'/ a !' <br />OWNER MAIL.UUNtlS NF- J4""' `�BIaS 34T�/�(pyy� <br />ITV nr ....,... <br />TENANT uAIL MDRf SS <br />ClPf PHONE <br />_ hnsan5 �yo �v✓ict' _ f�t2 5 G��ra� 1111%Ent ybn L bLb) 8S9-AY777 <br />NFMLCOBTBAC MMLAODRESS CITY ZIP PHONE SLATE LICENSE, <br />MECNAMCAL CONTRACTOR MAIL ADDRESS CITY LIP PHONE STATE LICENSE. <br />PLUMBING CONTRACTOR MAIL ADORESS CITY ZIP PHONE STATE LICENSED <br />_ __4 5360 00 <br />TRACT PPoCE OF WORK <br />5 �, <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />OE BE WORK AND SOUARE F TACGE INVOL EO flll VG �" C 1 �p G 6 <br />lZ k Hurl <br />CONTAGI PERS AN{� PHONE NO <br />ers COM C1 la r 4 of a1 a <br />Kedw <br />o miSC. rL .q. rn q S Wl evI <br />CI %2 `RR +�Fc 4i�Al, zo yc�. ors. }�o� <br />_ <br />M,• SnSkAo MtSL 'I= q 4C <br />4C{�' IeM <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />It Oydp(¢�� .. G <br />PROEos D USE DF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESf <br />NOT. 1HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />401 BLOCK DF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUC TION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAK LD. NAME <br />CONSIRILICT10N LOAN LENDER, AOORESS. TELEPHONE NUMBER <br />NATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />—FIXTURE <br />MECHANICAL <br />NO. <br />TYPE OF OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—AMNDLG UNITS <br />BATHTUB <br />; <br />I <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />' <br />LAVATORY (WASH BASIN) <br />SHOWER <br />' <br />UNIT HEATERS <br />'— <br />KITCHEN SINK 8 DISP <br />) <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />_ <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />— <br />EXHAUST FAN <br />I <br />- <br />I <br />SUBTOTAL S <br />SUBTOTAL S <br />' <br />PERMIT S <br />PERMIT ET <br />— <br />TOTAL FEE S <br />_ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBFn <br />FEF <br />nECFIPT NO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />_ <br />❑YFS ❑ NO <br />nUR DING <br />HEIGHTLIMITATION <br />NO OF DWELLING <br />SIZE OF BLOGIII <br />UNITS <br />PLIIMBINO <br />GRRGVPANCY <br />NO OF SIMES <br />OCCUPANTLOAD <br />BASEMENT <br />FF <br />MECHANICAL— <br />DYES ❑ NO <br />ADOI IIONAL PLAN CHICK <br />— <br />FIRE SPRINKLER REO'D <br />REASON <br />oiHEn <br />FlRE ALMMREO'D <br />RFASON <br />STATE BUILDING SonCHAnGE <br />_ <br />TYPE OF roesT <br />rinNS APrnoVED BY <br />F EVERETT <br />Punrlr. wonKa <br />AL SALES <br />[T:A:XCODE <br />— <br />TOTAL <br />— <br />— -1_— <br />DAIL <br />IS 3105 <br />