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APPLICATIGA FOR CONSTRUCI,JN PERMIT* <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259•b810 <br />❑ DEMOLITION COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �/J2,37& Chi <br />E6•'=—ate—' F — Z <br />P..F(4J Goi <br />TENANT MNLADDRESS CITY TIP PHONE <br />PWA10 <br />ARCH TECT OR DESIGNER MAII ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP ""ONE CI.Alt uunacr <br />l L <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE RTATE LICENSE <br />/ I <br />PIUMBNIG CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />EiT <br />CONTRACT PRICE OF WORK <br />cod A�Vll;ll <br />HEATING SYSTEM: )0 GAS El ELECTRIC ❑ _ <br />DESCRIBE WOW AND 596ARE FOOTAGE INVOLVED <br />CONTACT PE SON AND PHg NO <br />_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROPOSED USE OF BUILDING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIESI <br />BLOCK oF_r(iCC <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT <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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B 27 RCW AND 296.200 WAC. <br />PARCEL TAK LD. A9.'MBE <br />- '&6L <br />X a <br />NUMBER <br />CONSi7. L LENDER. ADDRESS. TELEPHONE <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE Nr <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />— <br />' <br />MC—A/HNDLG UNITS <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) �i <br />I <br />Q <br />HEAT PUMP <br />— <br />SWTWER / <br />- <br />' <br />UNIT HEATERSi— <br />KITCHEN SINK 8 DISP <br />- <br />CLOTHES DRYERS <br />DISHWASHER <br />- <br />RANGE HOOD103 <br />' <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />Q <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />Q <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />d <br />GASRANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />7- dff <br />EXHAUST FAN <br />I <br />I <br />' <br />I <br />' <br />lz <br />SUB TOTAL <br />S <br />' <br />SUB TOTAL S <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />S <br />' <br />TOTALFEE $ <br />^e ^tort I hoc nul V. <br />FRONTSFTPACK�� <br />REARSETBACK <br />SIDE SETBACK <br />PI AN CHECK NU(Anrn/ FEf, <br />/n <br />Rf CEIPT NO <br />USE _JNE <br />Lot AREA <br />VACANT SITE <br />DYES ❑ NO <br />FEES <br />VALUATION <br />'�7FEE <br />BUILDING. <br />110, <br />LIMITATION <br />NO NI ODWELLING <br />U <br />SIZE OF Bl0SINEIGNT <br />3 <br />b7i SF GAP ALA <br />PLUMPING <br />_ <br />MECHANICALGUP <br />OCCCUPANCY <br />NO N SlO ,S <br />OCCUPANT LSO/AD <br />BASEMENT / <br />I <br />j <br />/`A //'1 <br />CI YER B•FT/O <br />ADDIIIONAI. MAN GIECK <br />FIRE SPRINKLER RFO'O <br />REASON <br />-- <br />-- <br />—_�-Y_ <br />071IER <br />FIRE ALARM REO'D <br />RF ASON <br />STALE BUILDING SURCBARGC <br />— <br />L <br />rNBl lr, woNKa <br />TYPE OF coNRT <br />rl nes ArrRov4o By�TA <br />OF EVERETT <br />JCAL <br />SALES <br />- /Y.� <br />DATE 3 ')6CODE <br />IS J105 <br />TOTAL <br />