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APPLICATILA FOR CONSTRUCI.ON PERMIT <br />�W <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />7 DEMOLITION f1 COMBINATION I -I BUILDING 11 MECHANICAL !l PLUMBING W-SIGN <br />PROJECT ADDRESS --, <br />�" uC 57-- -7- �� G TH <br />,wuca MAILADDRESS cm ZIP PHONE <br />10,-ZQr) A.2 F <br />Rr s 4 <br />�43 -fscnx 4 Jm 4�s03 g ��y7c�_ <br />TENANT <br />MAILADDRESS <br />CITY <br />ZIP hHONE <br />gr <br />ARCHITECT OR DEB'GNFR <br />MAILADDRESS <br />CITY <br />ZIP PHONE <br />&444ASS' <br />13a <br />C.UC- SE- 5p <br />, fun rRE L.LE ! F lx)A 9�W-006 <br />-pa k • <br />GENERAL CONTRACTOR <br />ATE ?cis <br />MAIL ADOHESS <br />CITY <br />ZIP PHONE STATE LICENSE <br />P �r �ZL�• C'cc AR /E <br />MECHANICAL CONTRACT09 MAILADDRESS CITY ZIP PHONE STATE LICENSE <br />_*MBIH6 CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICEHSEA <br />"M <br />CONTRACT RICEO WOHK <br />Fl- <br />HEATING SYSTEM: C1 GAS ❑ELECTRIC Cl- <br />DESCRIBE WORK FOOTAGE INVOLVED <br />DESCRIBE <br />CONTACT PERSON AND PHONE NO, <br />'y691 iA w fI-Acc <br />I HEREBY CERTIFY THAT I HAVE READ AND EXANIINID THIS <br />A4 Z:, =),4f_1_ S-, AJ_,9T A # In <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING fyia.. - <br />PROVISIONS OF LAWS AND ORD114ANCES GOVERNING THIS TYPE OF <br />iz( <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />( OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLOCK ___ <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 />—a=`-�- <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X - y�:� / <br />PARCELTA\I.D. NUMBER <br />CONSTRUCOAN LENpER. ADDRESS. TELEPHONE NUMBER <br />TION L <br />SIBTGh TBRE SATE <br />CITY BI-SINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C-AIHNDLG UNITS - H.F.___ <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS-B.T.U. M <br />' <br />KITCHEN SINK & DISP <br />; <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />T_ <br />SINK (SERVICE - BAR, ETC.) <br />I <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />I <br />' <br />JWPERMIT <br />$ <br />SUB TOTAL S <br />i <br />PERMIT S <br />TOTAL FEE S <br />' <br />FRONTSETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CH C NU. BET FEE <br />/O <br />RECEIPT NO. <br />' <br />3 <br />Li=- <br />�� <br />LO <br />�o <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />-Z <br />AREA <br />VACANT SITE <br />�Es nNo <br />�Jm <br />BUILDINGIn�-J <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />S1ZE OF BLDG/T.I. <br />) <br />C <br />UNITS <br />PLUMBING <br />i <br />Z <br />MECHANICAL <br />OCCUPANCY <br />NOOFSTORIES <br />OCCUPANT LOAD <br />BASEMENT <br />GROUP <br />' <br />' <br />nVES IT NO <br />ADDITIONAL PLAN CHECK <br />I <br />—�—i-- <br />FIRE ALARM REOD <br />REASON <br />i <br />OTHER <br />FIRESPRINKLERREO'D <br />REASON <br />STATE BUILDING SURCHARGE <br />p5 <br />PUBLIC WORKS <br />) <br />TYPE OF CONST <br />PLAN POVED BY <br />CITY OF EVERETT <br />�I_ / <br />LOCAL SALES <br />y - \ ,`I <br />TAX CODE IS 3105 <br />TOTAL <br />OAT <br />r <br />