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<br /> APPLICATItnN FOR CONSTRUCTION PERMIT
<br /> CITY OF EVERETT• BUILDING DIVISiON
<br /> 3200 CEDAR STREET• EVERETT, Wq g820'I •259-8610
<br /> O DEMULITION Cl COMBINATION BUILDING ❑ MECHANICAL ❑ PWMBING ❑ SIaN
<br /> PROJECT ADDRESS
<br /> �j�i Z(o —Z-�r�� �i.� c� , `C.vf�..-et-
<br /> �WNER MAILpDDRE55/ �( /�
<br /> �� ��f f��'IIn /�K� �tf�. I"'�'�- �" ZIP PHONE
<br /> TENANT !I MAILAO�RE55 —`A� �� �^ �� 1lJ���
<br /> 1/ CIN ZIP PHONE
<br /> ARCMITECTOROESIGNER MAIUD�RE55
<br /> ��,,/y�J �. �n CITY 21P PHONE
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<br /> GENERA�CONTRACTOR MAI�qpDPESS
<br /> CITV ZIP PHONE STATELICENSE�
<br /> r�wm� �.� n,rnw CUt.t,N7'x'�E � ��M�'
<br /> MECHANICRLCONTRqCTOR MAILA�DRESS '
<br /> ��ry Z�P PHONE STATE LICENSE�
<br /> PLUMBINQ�ONTRpCTOR MAILAODRESS
<br /> CITV ZIP PHONE STATE LICENSE�
<br /> CONTRACT PRICE OF WORK �
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<br /> HEATING SYSTEM: GAS ❑ ELECTRIC ❑ ` _�`�`�
<br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED . ,,-.;,..;_�-
<br /> C NT CTPERSONANDP ONENO. p -C;b
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<br /> � I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS ` ���,�
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<br /> P OPOSED USE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.qL� :`�1t
<br /> S F PROVISIONS OF LAWS AND ORD�NANCES GOVERNIN6 THIS TYPE OF '"��'�;^�'S���..
<br /> LE6ALDESCRIPTION OF PPO� '(SHOWN BELOW ATTACH coaies) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR 5. r
<br /> � �.t� NOT. THE ORANTINV OF A PERMIT DOES NOT PRESUME TO aIVE
<br /> LOT�.�BLOCK pF ��i s,�In
<br /> - AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY � + �'��.�$
<br /> �' ,v •Z � OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE '��
<br /> , . PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE ' 'f,'�r���l
<br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH ���'���?+;���
<br /> ��S - DUD �{JSa- • OOJ� qppLICATION IS MADE AND I COMPLY WITH THE STATE +'-r:�r'"�
<br /> PARCELTAX I.D.NIIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. � .�"�-
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<br /> CONSTqUCiION LOaN LENDER,ADDPESS.TELEPHONE NUMBER /' '� � �".*4''��
<br /> SIONATURE � T ' �"��!
<br /> Ja ya DATE '`"Y'�f:.
<br /> CITY BUSINESS LICENSE N0. �,�6�.''��
<br /> PLUMBINO "`: '�:'=�.
<br /> NO. MECHANICAL Y
<br /> TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FlBTURE OR ITEM ' ;�
<br /> 3 WATER CLOSET(TOILEn �E . - �.
<br /> ' AIC—A/HNDLOUNITS—H.P. , '���"':+�°
<br /> BATHTUB � �,_r-,�k.
<br /> � ( FORCED AIR SYBTEMS—B.T.U. M E.A. � � `�'_�,
<br /> LAVATORY(WASH BASIN) � HEAT PUMP ' ''�`�+��{f
<br /> SHOWEF � UNITHEHTERS—B.T.U. M � .������'�
<br /> KITCHEN SINK&DISP � ��''�����
<br /> � � CLOTHES DRYERS � � � :;: ��
<br /> I DISHWqSHER � i ,§,;,
<br /> VENTILATION FAN t-�-
<br /> LAUNDRYTRAY , � �,.��,�«_;;,
<br /> 1 CLOTHES WASHER � � WATER HEATER � �'"�•���
<br /> URINAL , � ��`��::�-'-=`
<br /> DRINKINO FOUNTAIN WOOD STOVE , � . . ,
<br /> � METAL FIREPLACE(WOOD BURNING) �— �
<br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) �
<br /> BACKFLOW PREVENTERS ; GAS FIREPLACE �
<br /> _ SINK(SERVICE—BAR,ETC.) �
<br /> ' OA�RANOE
<br /> �
<br /> ' OAS FIpINO � .
<br /> � EXHAU�T FAN
<br /> � '
<br /> SUB TOTAL $ ' !
<br /> �` PERMIT $ SUB TOTAL $ �
<br /> ' PERMIT $ �
<br /> TOTAL FEE $ � TOTAL FEE S �
<br /> FOR OFFICE USE ��t�i ';
<br /> FRONT SETBA�K / .,:,�q 5�7gp��� SIDE SET� �,J
<br /> JI J/ �� PUNCHECKN�BER� FEE _� _ RECEIPTNO.
<br /> Go iv �� r
<br /> USEZONE �� LOTAREA VACRNTSITE FEES VALUATION FEE
<br /> f]YES f.l NO BUILDINO
<br /> HEIOHT LIMITATION / N0.OF DWELLING 512E OF BL /��. � 133
<br /> UNITS 'Z$C�/ �f. LI�/iA!(� -t- p�UM81NG �f�
<br /> 25 S,f. GAQA4E d
<br /> OCCUPANCY NOAFS70FIE5 OCCUPANTLOAD BASEMENT
<br /> GAOUP MECHRNICAL �
<br /> , • J-1 7. ❑ves RY�io
<br /> nEALARMREOD REASON AODITIONAIPUNCHECK �
<br /> �
<br /> FIRE SPRINKLER REO'D REASON OTMEfl �
<br /> STATE BUILOING SURCHARGE �`
<br /> TVPEOFCONST PLANSAPPROVEDBY
<br /> L1 CITY OF EVERETT PUBLIC WORKS � � _
<br /> � J t� LOCAL SALES
<br /> onre B y'�. TAX CODE IS 3105 TOTAL � _
<br /> � �
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