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APPLICATIO�1 FOR CONSTRUCTAON PERMIT <br /> (]yl � :ITY OF EVERETT• BUILDING DIVISIO� <br /> -1 � 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATiON BUILDING ❑ MECHANICAL ❑ PLUMBING C1 SIGN <br /> PROJECTADDRESS 5�T31 �5� Q�-� w� <br /> p Ep Mr11LPDDRE55 CITY ZIP PHONE <br /> ���,�o�d Itsr».�o lyylo � 12.�d d � aoo �r�Utuu� L�JP t�,ly-�� <br /> TEp�pM MAILADDRESS CITY ZIP � PHONE <br /> HITECTORbc51GNER MIILPDORE55 CIT1'� ZIP PHONE <br /> GENEMLCONTAnCTOR b'AILA DRESS CITV ZIP PHONE STATELICENSE� <br /> �umu aa C��.�L� CouNrr�� loM� <br /> MECHANICALCONTRACTOR MI'JLADORESS CITY ZIP PHJNE STATEUCENSE� <br /> PLUMtlINd CONTRACTOR MAILADlRE55 CITY ZIP PHONE STATE UCENSE Y <br /> fqNTRACTPR:CEOFWORN I LP � O3 HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> pE E�RK SOUARE AA u NVOL ED � ON AC7 vERS AN PHONE NO. ^ �/�� <br /> l /1 <br /> 3 y 1 z .r� -F 7 o a�7a Ti►� �t c+it a (i y - � �8 <br /> Y1 ��C # �1 ?O I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Q °�J APPLICATION AND KNOW THE SAME TO BE TRUE ANC�CCRRECT.ALL <br /> PROPOSED USE OF BUILDINO �ROVISIONS OF LAWS AND ORDINANCES OOVERNING THIS TYPE OF <br /> S F I2- WORK WILL BE COMPLIED WITH WHETHER SPECAFIED HEREIN OR <br /> IEGALOES�C�RI'�PTIONOFPROPERTY�SHOWNBELOW AnAC4TWOCOP'�E'S)/ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or1' `�'.— BLOCK _OF �OW�IY��n �- AUTHORITY TO VIOLATE OR CANGEL THE PPOVISION OF ANY ' <br /> h OTHER STATE OR LOCAL LAW REGULATINa CONSTRUCTION OR THE <br /> I �' S UI V� PERFORMANCE OF CONSTPUCTION.THAT I AM AUTHORIZED BY THE <br /> — OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICI' <br /> APPLICATION IS MADE AND I COMPLY NIITH THE STATE <br /> CANTRACTORS LAW 1827 RCW AND 296200 WAG. <br /> PARCELTAX I.D.NUMBER / � ' <br /> Ss ► 3 s -- oo U — o (�3 X I�v,r- L�i (.o'�� �/:�3 J R s <br /> CONSTBUCTION LOMI LENDER,ADDPESS.TE�EPNONE NUMBER <br /> SIGNATURE ���a y� DATE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBINO 'MECHANICAL <br /> � NO. TY?E OF flXTUHE OR REM FEE N0. TYPE OF FIIRURE OR ITEIN FEE _ <br /> � WH;ERCLOSET!TOILET) � A/C-NFINDLGI:NITS-H.P. ' <br /> BATHTUki ; FORCED AIR SYSTEMS-B.T.U. M E.A. ; <br /> � LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> - SH0INER ' UNITHEATERS-�'.T.U. M ' � <br /> , <br /> KITCHEN SINK F.DISP � CLOTNES DRYERS � <br /> DISHWASHER � � VENTILATION FAN �_ <br /> LAUNDRY TRAY ; RANaE HOOD _ <br /> CLOTHES WASHER � WATEH HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNING) O �'1�L <br /> FLOOH DRAIN � FIREPLACE INSERT(WOOD BURNING) , ' <br /> i_ <br /> BACKFLOW PREVENTE�iS ; GA5 FIREPLACE � __� <br /> SINK(SERVICE-BAR,ETC.) � OAS RANOE ' <br /> � GAS PIPINd �- <br /> � - EXHAUST FAN ' <br /> i � <br /> i i <br /> � <br /> � � <br /> SUB TOTAL $ i SUB TOTAL $ ; <br /> � PERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK � REAR SETB � SIDE SETBACK UN CHECN NUMBER FEE RECEIPT NO. n <br /> l/ . c�/ •J Uta�y7 3U /1�r ���� —_ <br /> usEzot+Fy � LOTAREA VACANTSITE FEES VALUATION FE�_ <br /> + ❑ves n No Z _----Lu-u-=p <br /> BUILOING <br /> HEIOHTLIM/ITJATI�ON � UNIT�DWEWNG SI�ESF��� L�„��✓G + � <br /> C/ I 83S Sf C�ORA�� P�UMBING � <br /> OCCUPANCY NO.OFSTOWES OLCUPANTLOPD 9ASEMPNT MECHANICAL <br /> GROUP� 2 N .a <br /> O YES O � II <br /> FIREPURMREOD REASON ADDITION�IPLANCHECK <br /> OTHER <br /> FIRE SPRINKLER PEO'D REASON � � <br /> STATE BUIIDING SURCHARGE <br /> TYPE OF CONSL �7UN5 MPROVED BY CITY OF EVERETT PUBLIC WORKS (J � �,� �r �( ���/� <br /> � '� TAX CODE SL3 05 TOTA� �� 7� � <br /> �-�J DATE 2 �)S <br />