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APPLICATIO, , FOR CONSTRUCTI jN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING XMECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: a7X/J S <br />S 4-1-1F- <br />TENANT <br />MAR. ADDRESS <br />r.IIY <br />!!I` PHONE <br />/w PnONF <br />ARCHITECT OR DESIGNER <br />MAR ADDRESS <br />CIrY ------ <br />:11' PIIONF <br />STATE IICF.NSE• <br />GENERA. CONTMLTOR <br />MMIAIX)RE55 <br />I:IIY <br />QEPENDr+4t E <br />�EAacn�U 41CQIU F"c6ftzN <br />w'41.47 <br />9f205 <br />155 4q1S 06AE4'Jl+.!!o[ol-jk/ <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />_Evr-,A <br />III' PIIONF <br />STATE LICENSEE <br />PLUMBING CONTRAC TOR MAIL ADDRESS CITY 11',' PHONE STATE LICENSE• <br />CONTRACT PRICE D< WIXNK J <br />24CN s — <br />HEATING SYSTEM: NGAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE: NO <br />��I 4co-0LA'S CN �S`l-`fw<f <br />L' Le*M C 1'0 G-Al C J VL2S LO N <br />- <br />FNRN�� �� <br />NA <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 />WORK WILL. BE COMPLIED WIT" 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 FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS DLAW Q118.27 RCW AND 296.200 WRAC. <br />X �Qwvr r I�L...(Y(„t / /i- /g <br />PROPOSED USE OF BUILDING <br />LEGALDESCAIPTIONOF PIOPERTY(SHOWN BELOWORATTACH TWOCOPIES) <br />LOT BLOCK OF _ <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIG Ar IRE O ,o 7�?- 0 DATE <br />LI CITY BUSINESS CENSE NO <br />PLUMBING <br />MECIIANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />UNITS <br />' <br />BATHTUB <br />; <br />_A/C—AAINDLG <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />_ <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />; <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />MEIAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT f <br />SUB TOTAL S <br />_ PERMIT S <br />JJ <br />TOTAL FEE $ <br />TOTAL FEE <br />FAA nmirF IIRF ONI V• <br />FRONT SETBACK <br />REAM SETBACK <br />SIDE SETBACK <br />PI AN CHECK NIIr�mnrn <br />rFF <br />RECEIPT NO <br />�JO� <br />USE ZONE <br />101 AREA <br />VACANT SITE <br />FE S <br />VALUATION <br />FEE <br />BIl11DING <br />OYES ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE Or BLDGnI <br />' <br />UNITS <br />PIUMRING <br />1 <br />OCCUPANCY <br />NO (%SI(Kb[S <br />O(:CUPANI LOAD <br />BASEMENT <br />MFCIIANIf.AI <br />i <br />GR011P <br />_ <br />❑YES ❑ NO <br />ADDOIONAI. PI AN CRT CK <br />i <br />FIRE SPRINKLER REO'D <br />REASON <br />rnuen <br />FIRER RM REO'D <br />RFASON <br />S1AE nDIIDINC SurtmoRCE <br />TYPE or roNsr <br />rInNS ArrnOVFD Br <br />CITY OF EVERETT <br />Pon' r won" <br />------ <br />LOCALSALES <br />--- -- <br />--- <br />TAX CODE IS 3105 <br />TOTAL <br />uaE <br />