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� APPLICATI�.N FOR CONSTFiUC1 iON PERMIT <br /> CITY OF EVERETT• BUILDI�;G DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION IY1 BUILDI'1G ❑ MECHANICAL I�f pLUMBING Cl SIGN <br /> PROJECT ADDRESS <br /> 5405 SFnN,.osT /-�,�,-- — Gv�.c—rr. /,�lAs� <br /> ON?JER MAILpDDRESS GITY ZIP PHONE /q.� <br /> SiL u�: � ASNE ��Colo /1���pLGwa�i\ Ln,� - l�"W ,..,,�r�I�.'�l��v Io�06) "]'J�>- C�1-� <br /> TEN�NT 41RIL PDORE55 LI ZIP F p�� <br /> JeS <br /> ARCNITECTOROESIGNER Ma1LADORE55 CITV 21P PMONE k(P� 9_J3_a�S <br /> ��,,; ,l:- .�+r,�.r.i� �/ Ai�=k� E�iEr�A�U 4�o�w r LTD. ��-uF i �o��c� <br /> GE RALCONTPACTOR MAILAOORE55 ��/O��l'n ��� �i�r�E�� gRATElIpJSE���� <br /> LC J C� �7 <br /> MECHANICALCONTRACTOP M�ILADDRESS �� CIiY + PHONE STATELICENSE� <br /> .LJAn�`� ��-ie'�I+•1�' �C� �Y �g� C�'+1k��.LIL ��l S�-OZ$� 1��/sP/S I�SNL <br /> PLUM9INOCONTP�CTOR Ma1LRDDRE55 CI1V ilP PNONE STATEUCENSE� <br /> CONTqAGT CRIGE OF WORK � � /� <br /> HEATING SYSTEM: ❑GAS O ELECTRIC [9� <br /> DESCPIBEWORKANOSOU�REFOOTAGEINVOLVE� WNT�CTPERSONA PHONEYO. <br /> _��2� SF�z. �'� � . 06 <br /> i2 Z �' �7�� ��/2�6 <br /> jI7GjC� /�3 � �j I HEREBY CERTIFY THAT i HAVE READ AND E%F.dAINED THIS <br /> PROPOSE�USE OFBUIL�INO APPLICATION AND KNOW THE SAME TO BE TRUE AND CCRRECT.ALL <br /> PROV�SIONS OF LAWS AND ORD�NANCES GOVERMNi,ThIS iVPE f1F <br /> WORK `NILL BE COMPLIED WITH WHETHER SP�GFIep HEREIN .^•R <br /> LEG�LDESCRIPTIONOFPROPEPTY�SHOWNBELOWORATf CMTWO o ie 1 NOL THE GRANTING OF A PGRMIT DOES NOT PRESUMF TO GNfi <br /> �or �= Z BLOLK oF � AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOULA71N0 CONSTPUC7ICN OR THE <br /> E -' PERFORMANCE OF CONSTRUCTION.THA7 I AM AUTHORIZED BY THE <br /> ' OWNER OF THIS Pi70PERTY TO PERFGRN, THE WORK FpR WHICH <br /> APPLICATION IS A1ADE AND I C�JM?LY WITH THE STATF <br /> PARCELTAXI.D.NUMBER CONiaACTORSLA iB.Z�RC � 96.?.JJWAC. <br /> (- uwnL�� � � <br /> CONSTRUCiION LO�N IENDE .�DDRESS,TELEPHONE NUMBER �'�O ._10.'?G I <br /> G Sv S Z I 8"'-' Si' S u/ —�_��.t. <br /> GNATUR U�TE <br /> ! � Q CIiY UU NE55 LICENSE NO. <br /> PLUM IN6 MECHANICAL <br /> NO. TVPE OF Fl%TURE OR ITEM FEE NO. TYPE OF FlXTURE OR ITEM FEE <br /> 'y WATERCLOSET(TOILEn � �q �- A/C-AMNDLOUNITS-H.P. �_ <br /> 7� BATHTUB � �q ;- FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> 'Z, LAVATORY(WASH BASIN) " � �- HEAT PUMP i <br /> SHOWER UNITHEATERS-B.T.U. M ZL50 � <br /> 7 KITCHEN SINK 8 DISP � - � CLOTHES ORYERS - i <br /> DISHWASHER � - VENTILATION FAN T— <br /> LAUNDRV TRAY 1 RANGE HOOD ; <br /> CLOTHES WASHER - �- � WqTER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURN!NG) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE-BAR,ETCJ OAS RAN6E � <br /> GAS PIPING ' <br /> I EXHAUSTFAN //� � <br /> � i <br /> � i <br /> � � <br /> � i <br /> SUB TOTP�. $ (� ; � SUD TOTAL 5 � <br /> PERMIT 5 PEFMIT $ (,o' +1 S � - <br /> TOTAL� '�E S � TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBALR PF.AR SETBACN SiOE SET�4CK PLAN LH CK NUMB: FEE � REGEIPT NO. <br /> 20 � Zo ' S v' � ".s ' <br /> USE20 LOTPREA VACANT te F ES VALUATION F� <br /> �Z � YES fl NO BUILDING �5 O Z � l/ <br /> NEIGHT LIMITATION N0.OF OWEUING SIZE OF BIOG/fl <br /> i UNITS �z 8� ,Yf Ll�/qJ4 � p�UMBMG i <br /> / S,' ',oR GS . <br /> OCCUPAN Y NOA�S10RiE5 OCCUPANTLO�D BASEMEHT �^/�! <br /> GR U9P � MECNANICRL C(/(J <br /> �'J M'I I NII� ❑YES NO � <br /> PIqER AP�IPEO'D REASON ADDIP.ON0.PUNCMECK 'J— <br /> � OTMER i i <br /> FlRE SPRINNLER REO'0 REASON " <br /> i <br /> O STATE BUILOING SVRCNFRGE ��� <br /> TYPEOFCON57 FLANSAPPPQVEDBY CITYOFEVERETT PUBLICwORKS <br /> �/I`} LOCAL SALE6 2�� <br /> .Q-h� onre S�jS SS TAX CODE IS 3105 TOTAL 1 r- <br />