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APPLICATI�1 FOR CONSTRUCT,ON PERMIT <br />.;ITY OF EVERETT • BUILDING DIVISIOh <br />3200 CEDAR STREET • EVEFETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING O MECHANICAL ❑ PLUM@ING p SIGN <br />PROJECTADDRESS ?y� SG�' <br />�/ S� 5 . W . --� <br />�1.vrTiu�c�ood rtsrnca l�/y/o rS.c� i�.�cf l2d � aoo� /�i.Gltau.� ltJfi �ly-.�3.�3 <br />T NAM MAILADDRE55 CIN ZIP PMONE " <br />�9GHRECTORDESIGNER A1�I�A�UFE55 CITV IIP PHONE <br />�' i'1 <br />M�ILAD�RE55 CITY ZIP PHONE STATE LICENSE Y <br />.ywin� uti ( J/w7Yiiti c olin� rr �� 1 o M� <br />MECHANICQCONTRACTOR MAILApDRE55 CITV Ilp PHONE STATEUCEN�E� <br />PLUMBING CONTRACTOR MAILADDflESS CITY Zlp PHONE STATE LICENSE � <br />CONTRACT PRICE OF WOAK <br />DE BE WOflK Ayq SO�UARE F TAGE INVOL ED � <br />) (Ari.CI� r� r.�.i.�. <br />.3 �7 �.Z 1� � $00 <br />�p,d�e� a84 <br />PROPOSED USE OF BUILOINO <br />5 F /Z <br />.EGAL DESCRSPTION OF PROPEHfV (SI{OWN BELOW QR{�TfACH 7W0 <br />�or <br />BLOCK _ OF I- �/(f • <br />(� 1 / A�- c�S <br />F 93 � <br />/ 3 — Oo0 . 08�1- 000r� <br />CONSTRUCTONLOMlLENDER,ADDRESS.TELEPHONENUMBER <br />PLUM91N0 � <br />NO. TYPE OF flKTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATF!TUB <br />LAVATORY(WASH BASIN) <br />SHOYIER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIIJ <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL $ <br />PENMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETHACK REMSETBACK <br />7�..�� 2S/ <br />USE20NE LOTAREA <br />� �� <br />HEIGMLIMITATION ) NO.OFDWELUNG <br />✓J(� UNITS <br />� <br />1 REO'D <br />J° <br />KLIER REO'0 <br />J � <br />)NSl'. <br />- i�i <br />N'/A <br />J r� <br />HEATING SYSTEM: �GAS O ELECTRIC [-' <br />ON AGJPER y�JO�Pi,�N�. L�/ 9- 81 70 <br />i� <br />�—�t- i K K v�wiu Q Vy - / i <br />I HEREBY CER'iIFY 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 60VERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />A NOT. S�HE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER ST.4TE OH LOCAL LAW REGUUITIN6 CONSTRUCTIQN OR THE <br />UTSG PERFORMANCE OF CONSTRUCTION. THAT i AM AUTfiORIZED BY THE <br />C OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND 1 COMPLY WITH THE STATE <br />— CONTRACTORS LAW 1827 RCW AND'2982:0 WAC. <br />X ��►�- �, �-.. I I 8 °►�l <br />SIGNANRE A n, I^�� � L�TE <br />V R �'I O <br />CIN 6USINESS LICENSE N0. <br />FEE NO. TYPE OF flXTURE OR ITi3M <br />� AIC—A/HNDLOUNITS—H.P. <br />; FORCED AIR SYSTEMS — 8 T.li I <br />i HEAT PUMP ` <br />UNIl' HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE <br />FIREPLACE INSER' <br />GAS RANGE <br />6AS PIPINO <br />SIDESETBACK � PUNCH'cCKt�UM6EP <br />• � � G�2 <br />VACANT SITE FEES <br />❑YE� O NO <br />�. �� BUILOING <br />�FB�p�y iL <br />v..�Si� G��/-�A�'+LC P:_A.dl'IG <br />BASEMENT � � MECMAh,CAL <br />❑YES CYNO <br />'�UDITIONAL PLAN CHECN <br />OTHER ��,�N <br />STATE BUILDING SURCHAR;fE <br />CI7Y OF EVEREIT PUBLIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 7oTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FEE�. � RECEIPTNO. <br />FEE <br />