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Fq32�} APPLICA71Q�1 FOR CON�TRUCT�ON PERMIT <br /> .:ITY OF EVERETT• BUILDING DIVISIOI <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUM.BING ❑ SIGN <br /> PROJECT ADDRESS s�I 3� � S'�' Q �C. �}� <br /> ER MRILADDRESS CITY IIP PNONE <br /> �OLvr�i�.t�Wood 1-�srn�a lyy/0 � I��d K'd #1 aoor /�.Glr�u LtJ.•4 t�yy-�3a.3 <br /> TENAM MAILqDDRESS CIT/ ZIP PHONE <br /> HITECTORDESIGNER MAILADDHESS QTV ZIP PHONE <br /> Qd U I�Thf/1 <br /> GENERAI.CONTRACTOR MAIUDDpESS CITV ZIP PHONE STATE LICENSE� ' <br /> �anu a.a C��a�, Cot�n� rr�� 1 o M1 <br /> MECHANICALCONTR�CTOR MAILAOORESS CITY ZIP PHONE STATELICENSE� <br /> PLUMBWQ CONTRACTfM MRILADDRESS CITY ZIP PHONE STATE LICENSE• <br /> CONTRACi PHICE OF WORK - <br /> � � °� D HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> CE EWOHKA SW�RE TAOEINVOLV D , O ACjPERS �H PHONENO. <br /> Ly 9- 8I5S <br /> 358a .r� f s�� yb �a�q TA�t �t�an� (iy - �� �8 <br /> g �/C � a �� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPoSED U5E OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S F /Z PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEOALDESCRIPT70NOFPROPERiV(SHOWNBELOWORA7TACH7WOCOPIES) WORK WILL BE CAMPLIED WIT}i WHETHER SPECIFIED HEREiN OR <br /> /—�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�_4� e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY ' <br /> J � OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br /> O�L��L[.{lLy}. ay�p�5 PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTN(I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 29ti�00 WAC. <br /> 8I3S _ D�p - L � ��.�� " //'� <br /> CONSTAUCTION LOMI LENOF:i,�ODRESS,iELEPHONE NUMBER X �Y/i� � (/�/�.` /��3 f ✓ <br /> ..- SIONATURE Q����� OATE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBING 'MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR REM FEE <br /> WATER CLOSET(TOILEn � AIC—AMNDLG UNITS—H.P. � <br /> y BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUAIP � <br /> SHOWER � UNI7HEATFqS—B.T.U. M � � <br /> KITCHEN SINK&DISP ; CL' iHES DRYERS ; <br /> DISHWASHER i VENTILATION FAN � <br /> LAUNDRY TRAY ; RANOE HOOD ' <br /> i <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL � WOOD STOVE � <br /> DRINKINO FOUNTAIN ; METAL FIREPLACE(WOOD DURNING) p ���� <br /> ROOR DRAIN � FIREPLACE INSERT(WOC �EiURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR, ETC.) � GAS HANGE � <br /> ' GAS PIPING ' <br /> i E%HAJST FAN , <br /> i i <br /> i i <br /> i � <br /> � � <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> - PEFMIT $ , PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONfSETB�-/ REAe ET K � SIDESETBACK�/ PUNC��/�U��fi FEE� RECEIP///�n <br /> C7 a <br /> USE ZON � LOTAREA VACANT SITE FEES VALUATION FEE <br /> v V ❑YES ❑ NO BUILDING Z�7 �z¢ /2, � <br /> MEIGHTLIMITATION f NO.OFDWELUNG SIZEOFBLDG?.I. �� <br /> y � UNITS 'j (3'Z SF Ll�i•Jfa � � <br /> �c� PLUM9ING � <br /> OCCUPANCY NO.OFSTONIES OCCUPANTLOAD BAS MENT GA�`� <br /> GROUP� 2 ❑YES � 'AECHAi:CAI `, I <br /> N n � <br /> FIPEAURMREO'D HEASON AUDITIONr1LPUNCNECK �f- <br /> � <br /> N� OTHER ��� � <br /> FIRESPRINKLERREO'U REASON <br /> D � i <br /> �1 STATE BUILOING SURCHARGE J.y� <br /> w� <br /> TYPEOFCUNST. PUNSMPROVEOBY CITYOFEVERETT PIIBLICWORKS � <br /> LOCALSALES <br /> �-�v DATE 6�y TAXCODEIS3105 7oTnl � <br />