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• <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •(425)257-8810 <br /> ❑ DEMOLITION 0 COMBINATION p(BUILDING 0 MECHANICAL 0 PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: 5q ,), Sec.Inv rsT F)UP <br /> Suss R:tt e.,LSt. Y015 btvcrly Rivd EuuYerr �1Fi.2o'3 50-/J12 or 308-3)7y <br /> OWNER M IL ADDRESS CITY ZIP PHONE <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE ' <br /> SUST RI I e_ CcAStructloA $Oi5 6euccly '31vx.I EvutH- ri8.20-1) 'OS1 -3t7� <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE r - <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE r <br /> CONTRACT PRICE OF WORK _ <br /> /3/G23 HEATING SYSTEM: 0 GAS 0 ELECTRIC la--- <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO <br /> Coc,S4rz,c4- ').;Pttx 1.23G `p LPtr Srde 01A4-f Recj% 3ass-317ct <,,r .SU-1512 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS • <br /> PROPOSED • <br /> USE of BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF . <br /> 'OUP(e I L.,u Ctam I Isf (Leif;n 5 WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACHYWO COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE • <br /> . LOT i- BLOCK OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF 2 ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> LSLeir(' �c( PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE .. <br /> 1 20� 2 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH . <br /> J APPLICATION IS MADEjjjj AND I COMPLY WITH THE STATE <br /> PAR EL TAX LD.NUMBER CONTR TORS 27 RCW ND 296.200 WAC. t��y <br /> • <br /> CO STRUCTION LOAN LENDER,ADDRESS.TELEPHONE NUMBER X // I`� /-C7_2- l r <br /> L',1W00d I11Or-f c5 e /lni.+a04 775"99(;6. SIG AT RE C ` DATE <br /> • CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> u WATER CLOSET(TOILET) A/C—A/HNDLG UNITS <br /> 2 BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP i ' , <br /> SHOWER /y UNIT HEATERS <br /> KITCHEN SINK&DISP a CLOTHES DRYERS ' <br /> a DISHWASHER a RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> P.. CLOTHES WASHER WOOD STOVE • <br /> ' URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) . . <br /> FLOOR DRAIN GAS FIREPLACE <br /> BACKFLOW PREVENTERS GAS RANGE <br /> SINK(SERVICE—BAR.ETC.) GAS PIPING <br /> G EXHAUST FAN <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ i PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: . <br /> FRONT SETBACK REAP SETBACK SIDE SETBACK PLAN CHECK NUMBER FE F . RECEIPT NO • <br /> 5' 36'-1TDln stoPe- /0 ' -5 41/7 -��,112/ <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE - ' <br /> • <br /> R-Z I—4.T 22-` Yi f2'iES ❑NO BUILDING <br /> HEIGHT LIMITATION NO. DWELLING SIZE OF BIDGITI 1 <br /> 24/ UNITS <br /> ( PLUMBING i <br /> -- - _ — <br /> OCCUPANCY NO OF STORIES OCCUPANT LOAD BASEMENT MECHANICAL <br /> GROUP <br /> ❑YES 0 NO _— —__.-. __ <br /> FIRE SPRINKLER REO'0 • REASON ADDITIONAL.PI AN CHECK <br /> • <br /> OTHER <br /> FIRE AYARM REO'D REASON --I <br /> STATE BUILDING SURCHARGE <br /> TYPE.OF CONST PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS ' <br /> LOCAL SALES -- <br /> DATE TAX CODE IS 3105 TOTAL <br />