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APPLICATA FOR CONSTRUCON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257-8810 4myr <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING PVMECHANICAL ❑ PLUMBING F- SIGN <br />I PROJECTADDRESS 7* , L• I <br />dam•. s� <br />OWNER <br />MAIL ADDRESS <br />CRY ZIP PHONE <br />� SE/�re Os.1 <br />JOW !V92G <br />Z7 ` AVE• NjOr 4Z5:: <br />25-2 - 3//1 <br />IENANT <br />M ADDRESS <br />CITY ZIP PlIONE <br />tw-JNEiL <br />ARCHIZT OR DESIGNERMAILACDRESS <br />CITY IIP PIIOIIC <br />GENE fIRACIOR <br />MARAOORESS <br />61Tr ZIP PHONE <br />STATE LICENSE. <br />MECHANICAL CON FACTOR <br />MAILADDRESS <br />CITY ZIP PHONE <br />STATE LICENSE• <br />ekyne-tam <br />-Tm5zT <br />w1w ;y <br />4zs- uz -d//4 <br />PLUMBING CONTRACTOR <br />MMLPWPESS <br />CITY ZIP PROVE <br />IAT lKENSE• <br />tV14AQ AcSn 7_7-DT <br />CONTRACTPRICE O[ 1YORv, <br />a DO • �� <br />HEATING SYSTEM: h?�GAS �I ELECTRIC ❑ <br />DescNIDE woRB AVD SOUAR[ [OOIAGE INVOLVED <br />/SAT/0A% E A <br />CONTACT POISON AND PRONE NO <br />_ <br />bRc Fu +� <br />7,S-252-3//f- <br />I HERESY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANU 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 70 VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING 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 A D I COMPLY WITH THE STATE <br />XONTRACTO 27 AND 29L200 WAC. <br />4-7-0/ <br />PROPOSED US of nmmlxc <br />,(l�/YIE�'iA%liV <br />LEGAL DESCRIPTION OE PROPERTY ISHONIN DELOVV OP ATTACH WCOPIES) <br />LOT BLOCK OF <br />PARCEL TAXI D NUMBER <br />CONS (RUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />SIGNAIURL �- -P DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NO—AIHNDLG UNITS <br />BATHTUB <br />FORCED AIR SYS/EMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PI IMP <br />! <br />SHOWER <br />UNIT HEATERS <br />_ <br />_ <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <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 />! <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 $ <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT S <br />_ <br />TOTALFEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SET BACK I PEAR SETBACK SIBS SETBACK I PLAN CHECK NUMBER FEE PECEIPT NO. <br />LOTAREA <br />DYES ❑ NO_� BUILCING <br />HEIGHT LIMITATON <br />OF OWELLMG <br />SIZE OF BLDOT I. <br />INO <br />UNI15 <br />PLUMBING <br />OC�CUU;ANCY <br />NO DF STORE: <br />OCCUPANT LOAD <br />BASEMENT <br />NECNANICAL <br />❑YES D NO <br />._... <br />..�.- <br />......... <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SVRCHARGE <br />CITY OF EVERETT PUBLICWOHKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />