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APPLICATIpN FOfR CONSTRUCT�ON PERIVIIT <br />.:ITY OF EVERETT • BUILDING DIVISIOI, <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8A10 <br />O DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />PROJECT ADDRESS �y p8 5.G /�_ S'} S�I <br />'�/�l/o r� I?.�d 12d � aoo <br />cin zir <br />PLUMBINOCONTRACTOR MAILADDRE55 CI.Y ZIP PHONE STATELICENSE� <br />D-��RK A SOUARE FO�T�GE INVOLy'cD , <br />-t�, n L... <br />�1 u ��rnA :- <br />3 Y l 2 .g4 f �7d yd J <br />� A.cic # � OS <br />PROPOSED USE OF BUILINNO <br />J'r � � <br />LEGALDESCflIPTIONOFPROPEfitt�SHOWNBELOW ATiACHTNOCOPIES) <br />LOT� BL'JCN pF�wd. A'1� <br />� larAs � <br />i� 1 a.,., 9_yl b <br />PAPCEL TA% I.D, NUMBER <br />$I�S-ooO- D$3 - ��o <br />CONS' • ��OH LO�N LEN�Eq, AODRESS. TELEPHO:JE Nl1M8ER <br />PLUMBING <br />NO. TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINd FOUNTAIN <br />FLOOq DRAIN <br />SUB TC•TAL <br />PERMIT <br />TOTALFEE <br />FOR GrFICE USE ONLY: <br />FRONT SETBACK � REAR SETBACK�� <br />yJ G� 7 <br />USE20NE _ � LOTAREA <br />MEIGHTl1MITATION NO.OFDWELl1NO <br />7 � UNITS <br />OCCUPANCY NO.OFSTOPoES <br />GR P� � <br />FIRE AIARM PEO'D <br />�J v <br />FIflE SVRIN,KIIER REO'D <br />N � <br />TVPE OF CONST, <br />►! - rJ <br />.I <br />� <br />HEATING SYSTEM: pjTGAS ❑ ELECTRIC ❑ <br />�ONl ACJ PE RSq+ ANy PHONE NO. <br />Kl.�n /'nha l.[J9_ 57/CR' <br />l A�t[ T/tMair.�.c (iy9- Sl178 <br />I HEREBY CERTIF�' 'I�iAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KI:,. W THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LA"!S AND ORDINANCES GOVERNIN6 THIS TYPE OF <br />WORK WILL BE C�MPLIED WITH 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 />OWNEA OF THIS PROPERTY TO PERPORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X l�v,r- T�., � t1�8/•r�( <br />SIGNATURE U� y a 4� DATE <br />CITY BUSINESS LICENSE NO. <br />FEF NO. TYPE OF FlXTURE OR ITEM FEE <br />� A/C—AIHNDLGUNITS—H.P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNITHEATERS—B.T.U. M <br />� CLOTHES ORYERS <br />� VEN"i ILATION FAN ^ � � p(,� <br />; RANGEHOOD <br />� WATER HEA?ER <br />' WOODSTOVE <br />� 1 METAL FIREPU�CE (WOOU BURNINGf .�, <br />GAS RANGE <br />OAS PIPING <br />SIDE SETBACK PUN <br />1 � � <br />VACANT SITE FEES <br />❑YES ❑ NO BUILDINQ <br />)F BLDG/CI. — <br />�%7 S� L�V��� PLUMBING <br />�2u �r` GA2A � <br />BASEMENT � MEGNANIC�L <br />❑YES QYNO <br />AUDITIONAL PUN CMECH <br />OTHER <br />STATE BIIIIDING SURCHARGE <br />CITY OF EVEREIT PUBLIC WORKS <br />LOCAL SALES — <br />TAX CODE IS 3105 TOTAL <br />FEE <br />SUB TOTAL $ � �/l: — <br />PERMIT $ Y� <br />26 <br />