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� �� / <br /> ��1 APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY QF EVERETT•BUILDING DIViSION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> i-1 DEMOLITION fl COMBINA710N BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJ'ECT ADD!iESS `, <br /> �j L' � � - Z i".� �l" ' �4-�''� �'" - 't,,�-f.� <br /> ���ER MAllAODRESS CI�Y 21P PHONE <br /> u� ��f (�{�-t!o 1�u 1.�. � c..,,.t< am> t�c�4( PH� (o�!`I fC! � <br /> TENANT MAILpDDRE55 <br /> ��.. ��s ✓� L�`iS fl133 <br /> ARCMIT CTORDESIGNER MAI�ADORE55 CITV ZIP PMONE <br /> � Jd�lY)L �t �9 lY1Pwl <br /> OENERALC.ONTqACTOR MAILpDC9E55 CIT' ZIP PHONE STATELICENSEt <br /> !sa-rnt C� �M�'Y1Ly �l.t.N T��E o l O p.�3 <br /> MECHRNICALCONTRACTbR MAILADDRESS CITV 21P PHONE STATEUCENSEt <br /> PLUMBING CONTRACTOR MAILADDRE55 CITV ZIP PHONE STATE LICENSE� <br /> CONTRACTPflICE OF WORK <br /> HEATING SYSTEM: CiAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE FOOTRGE INVOWED C NT CT PERSON AN�P ONE NO. — <br /> QG (o�f 8/ � <br /> � � � � � fi s 6�fq 8 a3 <br /> � , I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P OPOSED USE OF BUILOIN( APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRE:T.ALL <br /> S PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T PE OF <br /> LEOALOESCRIPTIONOFPROPERTV(SHOWNBELCW ATfACM7WOCOPIES W�RK WILL BE COMPLIED WITH WHETHER SPECIFIED HER"IN OH <br /> �or�_BLOCK oF � NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME '�O OIVE <br /> ' AUTHORITY TO VIOLATE OR CANCEL THE PROVISION �F ANY <br /> OTHER STATE OR IOCAL LAW REQULAT�NO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED AY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � PARCEL U(I.D.NUMBER O � CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> CONSTRUCTION LO�N LEN�ER,pUURESS,TELE HONE NUMBER X���y/�f� �Q L�1_ yl v� I`'J�, <br /> SIGN�TURE �ay� (' DATE <br /> Y <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBIN6 MECHANICAL — <br /> O. TVPE OF FlXTURE OR ITEM FEE NO. TYPE OF FU(TURE OR ITEM FEE <br /> WATER CLOSET(TOILEn � A/C—AIHNDLG UNITS—H.P. �— <br /> BATHTUB ; ( FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ' <br /> ( DISHWASHER� � VENTILATION FAN � � <br /> j LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL ' WOOD STOVE � � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ' � GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � QAS RANGE , <br /> ' GAS PIPING � <br /> i H EXHAUST FAN � <br /> i � <br /> ' � _ <br /> SUB TOTAL $ ; SUB TOTAL $ • ' <br /> PERMIT $ i PERMIT $ � <br /> TOTALFEE $ � TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETgqCI{„J REAR SETBACK SIDE SETBPCK PLAN CMECN NUMBER FEE ..it RECEIPT NO. <br /> Zb,� � lo '� 7.S"� - , ��� <br /> — <br /> use zor{E, � LOT APE� VACANT SITE FEES VALUATION FEE _ <br /> �' nves n No <br /> eui�oiNo � Z � <br /> HEIGHT LIMITATION � NO OF UWELLING SI2E OF BLDGR.1 <br /> IINITS 2(d3U .$.F• LIV�N/4 + p�UMBIN6 O� i�, <br /> s A�t4�iE <br /> OCCUPANCY NO.OFSTOPIES OCCUFANTLORD BASEMENT <br /> GROUP � MECHaNICAL ��(� OO <br /> �'3 V�� Z ❑YES PrNO <br /> FIRE URM REO'D REASON ADOITIONRI,P�AN CHECK i <br /> OTHER <br /> FIRE SPRINKLER REO'� REASON <br /> � <br /> STATE BUILDING SURCHARGE �� <br /> TVPE OF CONSI P�ANS APPROVED BV CITY OF EVERETT 7UBUC WOPKS i` <br /> �� LOCAL SALES �O �v L� <br /> —I� DATE S 7 �P TAX CODE IS 3105 70TAL ' O�- 00 <br />