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APPLICATION FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 IF (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUI ING MECHANICAL ❑ PLUMBINGJOSIGN <br />PROJECT ADERESS: tQ;oPa - `fir AJP lh) <br />A-✓e L-Js✓rra<P i� c..J 914'zo <br />FMNFD M4l ADDPE55 brc Im PHONE <br />TENANT M41 ADME55 an TIP PINIONS I <br />ARCHTECTORDEbGNEN MAl1 ADDRESS City )Ir INCNE <br />GENERAL CONTRACTOR MAIL ADDRESS C11Y )Ir dgME STATE LICENSE <br />IFADNF STATE LICENSE r <br />IIF PNONF STATE MENU <br />t TRACT PmcE ar NKIRK � p C� <br />_ 8S. <br />HEATING SYSTEM: AS OrELECTRIC ❑ <br />DESCRIBE MORN AND SODA EIMPACT INVOLVED <br />CONTACT PE RION AND PNEM'F NO <br />I 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 CANCEI 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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT/(JqACTORS LAAWj\1827 R/CjW AND 296.200 WAC, <br />XC�E'L�^"'A-.L\l ✓V <br />PROPOs[DusE Dr BORROW, f <br />l <br />LEwH.D[scRlnnaN Dr PTpPERm HsIawN BELow oR nnACN Two ccNNFs1 <br />LOT BLOCK Or <br />PARCEL TO 10 NuMBED <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE POMADED <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AlHNDLG UNRS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A 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 />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK ISERVICE — BAR, ETC J <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />SUB TOTAL S <br />_ <br />PERMIT S <br />PERMIT f <br />TOTAL FEE S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRONT SF TRACK <br />DEAR SET BACK <br />SIDE SEU.CK <br />PlANC11ECK NUWR <br />r F <br />RFCFIPTND <br />usf )DINE <br />101 AREA <br />vuAI PI[ <br />DYES D NO <br />FEES <br />VALUATION <br />FEE <br />BUI d4G <br />_ <br />N[IOIII IIVIIAIK)N <br />NO OF DWEIDNG <br />ANTIC <br />SIZE OFBlObfl <br />r111MRIV0 <br />7DCCIIMNLY <br />GROUP <br />NJdSIMIS <br />IX;LIIPANI IUAD <br />BA$F4[NI <br />O+FS ❑ rv0 <br />MFf.NANK:AI <br />T <br />AM14MAI MMCIIFCK <br />- <br />FIRE SPRINKLER PLO 'D <br />REASON <br />OIN[R <br />FIREALARMR[0'D <br />Rf ASDV <br />SIRE IRRDNO SHICRARGF <br />YYrE or CONSr <br />rinrvs ArrnovrDD+ <br />PATE <br />CRY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3TD5 <br />FUTALI. MKw.S <br />TOTAL <br />— <br />—-L— <br />i <br />