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APPLICATIOA FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />FI DEMOLITION 11 COMBINATION wi BUILDING 11 MECHANICAL I ; PLUMBING F1 SIGN <br />PROJECT ADDRESS <br />OWNER 14AIL ADDTIE-,,+, p 7' CITY ZIP P11oNE <br />TENANT <br />MA!:. ARWXSS <br />� CITY <br />71P <br />- PHONE <br />AnCRITF.CT OR DESIGNER <br />MAII. ADOR'�SS <br />CITY <br />71P <br />PHONE <br />GENERAL CONTRACTOn <br />MAILADOnE55 <br />CITY <br />711, <br />I'llow <br />SIAIF IICFNSE� <br />s CvNST. <br />2 9r=:?✓✓✓� �i�jjelhll, <br />VAI <br />cJQz2-3 <br />43SS'&� <br />MFCIIANICAI CONTRACTOR <br />MAIL ADDRESS <br />CI TV <br />711, <br />r110�.e <br />STATE IICENSE A <br />PI I I MR INC. CON T RAC I OR <br />MAII. AOORFSS <br />CITY <br />71P <br />PIIONr <br />STATE 1ICFNSF- <br />CONTFACT rn!CF.Or WOnK <br />HEATING SYSTEM: I I GAS I I ELECTRIC f I <br />DFSCP W F. WOnK AIID SOIIMF. FOOTAGF IN'IOLV2D <br />�v/s� s Rf.✓74 � �.yfls:F���i FoK _ <br />CONTACT I'En SON AND PHONE NO <br />' _��H �K.:.'�. rl.!- �%'r:. .��'L <br />`"U4C f-i•R=/9D <br />�� �n�A ��- p' T, /' - <br />37 'l`-Y <br />I HEREBY CERTI=Y THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND {NOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COIAPLIEU WITFI WHETHER SPECIFIED HEREIN O l <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 REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATI N IS MADE AND I COMPLY WITH THE STATE <br />CONTRA RS LAW . 7 RCW AN 296.200 WAC. <br />X <br />PnornsnO USE OF RUILOING <br />I FOAL nFSCRIrnoN of rnorenry(SHOWN BELOW On AT TACT Iwo corers) <br />LoTJ/� a. — BLxK _[.�'� OP��%1 a% EVEf,EJ/ _ <br />7 <br />l/i7,rOCOF• <br />PARCEL TAX I.D. NUM9En <br />CONSTRICTION I OAN LENDER. ADORESS. TELIFF'RONF. NUMRFn <br />BIGNAT P / <br />\UCENSF. <br />DATE <br />CITY BUSINESS NO <br />PLUMBING <br />MECHANICAL _ <br />NO. _TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />_ <br />�— <br />AIC-A/HNDLG UNITS-H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />LAVATORY (VVLRH BASIN) <br />I <br />HEAT PUMP <br />�— <br />SHOWER <br />UNIT HEATERS - B.T.U. M <br />' <br />KITCHEN SINK d DISP <br />_' <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />VENTILATION <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />- <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />_ <br />I ' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />_ <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE_ <br />_ <br />SINK (SERVICE - BAR, ETC.) <br />I <br />GAS RANGE <br />_ <br />GAS PIPING <br />EXHAUSTFAN__ <br />I <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />I <br />_ PERMIT $ <br />F <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />FEAR SrTBACK <br />SIFESETBACK <br />PI AN CIIFCK NIIMnrn <br />rEF <br />nFCFIPT NO <br />USF.7ONF <br />LOT AREA <br />VACANT SITE <br />FEES _ <br />VALUATION <br />FE-E <br />I IYFS II NO <br />III III nlNf, <br />' <br />I <br />HE IGI IT I IMITATION <br />NO. OF DWELLING <br />SIZE Or RIOGR 1 <br />— <br />UNITS <br />I'LIIMnING <br />' <br />OCCUPANCY <br />NO nl SIOn1Cn <br />OCCUPANT LOAD <br />BASEMENT <br />MFCI IANICAI. <br />i <br />GROUP <br />I <br />I IYES II NO <br />-- <br />NIf11II0NAI. PLAN CIIff.N <br />------ <br />' <br />I <br />TIRE ALARM twon <br />REASON <br />OiNEO <br />I <br />i _— <br />_ <br />TIFF SPn1NKIFnnFOD <br />REASON <br />--'-- <br />I <br />STATE BUILDING. SIIRCIIAIIGF <br />' <br />rvrEnFrrnISI <br />PlnnlsnrrnnvrnnY <br />CITY OF EVERETT <br />runLlcwoRKS <br />1 <br />— ' <br />LOCALSALES <br />-— -- -- <br />- <br />- <br />TAX CODE IS 3105 <br />TOTAL <br />DAIS <br />_- <br />