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APPLICATIA FOR CONSTRUCI%N PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257.8810 <br />❑ DEMOLITION COMBINATION n BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS I�q26 27fiT Avt ✓ w EPETT W4 382o.3 <br />OWNER MA-LACORESS CITY ZW PIgNE <br />PusHKe�� )EIDaF Relw 4426 27TRKE tN. L KTCCiI wA 99z03 C425� 247-0475 <br />TENANT N IA- MAIL ADDRESS CITY ZIP PHONE <br />�UsHrc-,+ �EIOV-c R�v�Yd <br />GENERALCON1RACTOR MAIL ADDREP <br />CITY ZIP PHONE STATE LICENSE <br />PVSHy-m - �I9f <br />MECHANCAL CONTRACTOR 'MAIL ADDRES <br />q <br />uU AriyM d DeTD2'E <br />CITY ZIP PHONE STATE LICURE• <br />PLUMBING CONTRACTOR ^ MAIL E� bEI me <br />L-uCu,lcrl /CFTI VI`C <br />OC�ItV I TIP PIKK1E SLATE IKENSE• <br />F 1� <br />CONTRACT PRICE OF WORN <br />�l 2 <br />HEATING SYSTEM: �K(9gS DIELECTRIC <br />DE Iw E WORK um sa RE FOOUGE Prvavco <br />L✓IVc PALE T� E)CISTtivct <br />coerACT n[nsa+Arm Prwrm r <br />DAti (425)3)6-9964 <br />NOM(= <br />CvLr- Uls) 267-o47S- <br />1 HEREBY CERTIFY 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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RcGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT 18.27, RCW AND 296.200 WAD. <br />X _ yl� l <br />PROP•o_/ED USE of BUILDING <br />.i1,V!(ti FAHII y f(WC- bPl r/oN _ 8�o ROOM <br />LEGAL KSCRIPTION GF PROPERTY )SHOWN BELOW OR ATTACH IM COPIES) <br />LOT BLOCK OF <br />PARCEL i+v D.INMBER <br />coNsr,Rl1xTloN LonN LErmEn. ADDREss. TELEPHONENwnBEP <br />1v E <br />SILNATURL� 'DATE <br />CITY BUSINESS LICENSE rro. <br />PLUMBING <br />MECHANICAL <br />NOT <br />—TYPE OF FIXTURE OR ITEM <br />F_E <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />I <br />WATER CLOSET (TOILET) <br />A/C —AHNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />I <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />\ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />I <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE Sl <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />SUR SETBACK <br />SIDE SETBAC� <br />Lr1ECK NUMO[F <br />FEE <br />RECEIPT NO <br />USE ZON <br />LOTAREA <br />VACANT SITE <br />:)YES NO <br />FEES <br />'VALUATION <br />FEE <br />_ <br />BUILDING <br />Z <br />HEIGHT RURADON <br />D-li� ' <br />NO OF DNELLINO <br />°µTB <br />SIZE Of Bt t1 <br /><4sz 23 <br />PLUMBING <br />CCLUPANcr <br />�RW <br />'S -I <br />PC CF STDRES <br />OCCUPANTLOAD <br />OAXDLNi <br />;:YES I O <br />MECrIANCAt <br />ADOOweAI PLAN CHECK <br />FIRE SPNNKLERPEOD <br />REASON <br />ONES <br />FWEAIMMPEOO <br />REASON <br />STATE BUILDING SUPLIIBpGE <br />TYPE OF CONST <br />PLNISAPPROVED BY <br />DAIc S !° <br />CITY OF EVERETT <br />LOCAL SALES <br />TA%CODE IS 3f05 <br />PUBLK: WGRr.S <br />TOTAL <br />