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_ <br /> �ff S 1 �^ � 2�3�/ f�o�lA�R�� w/l3/�-st.,���.vT�> <br /> APPLICATION FOR �ONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 9200 CEDAR STREET • EVERETT, WA 98201 •25�-8810 � <br /> ❑ DEMOLITION �1 COMBINATION [�t BUILDING i-cl MECHANICAL kl PLUMBING ❑ SIGN <br /> PflOJECT ADDRESS <br /> 5725 �o�"' Dr. �J . �er�-f� <br /> , <br /> OWNER MhILAUDf1E55 CIIY ZIP PHONE <br /> Aalar�Ftrmocr_.Tnn 12811 Sth Ave. W �!A—�0� Ew � Ffi 9R7 <br /> 04 20_6/513-9006 <br /> ' IENANT A1pILAUUf1E55 CRY 21P FIIONE <br /> ARCIIITECTOFlOESIONER MAILA�ORE55 �IIY IIP Pf10NE <br /> GENERAICONTRACTOR MAILrIDUf1E5S Cltt 21P PHONE STATELICENSEI <br /> SP7 c H a� 7nc 12871 R h Av w �* 9n7 Fti, ty 4TA 9R9ne �p�/q1z ann� SF�FCTT110KN <br /> MECH�NICALCONTflACTOIi MAllAU0RE5S CIN ZIP Al10NE STATELICENSE� <br /> PLUM9INOCONTRACTOR MAILADDRESS Cltt ZIP PHONE SiATELICENSE� <br /> CONTRACT PRICE OF WO(iK <br /> iiEATING SYSTEM: 64 GAS ❑ELECTRIC ❑ <br /> 0 SCFI E WORN AN�O SOUAFE FppTM'S INVOLVEO COHTACi PEf150NANO PHONE N0. <br /> Construction of one ii� le ami.l esid nce d Clark 206/513-9006 <br /> Beverly King 206/513-9006 I <br /> I HEREDY CERTIFY THAT I HAVE READ AND EXAMINED THIS �I <br /> PHOPOSEO USE OF BUIl01NQ APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL ' <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> Sinale famil c3w2111I1 WORK WILL BE COMF'LIE� WITH WHETHEF SPECIFIED HEREIN OR <br /> . LEOALDESCRIPTIONOFPqOPERtt�SHOWNOELOWORARACHTWOCOPIES) NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or Z�o eiock or AUTIiORITY TO VIOLATE OR CANCEL TIiE PFOVISION OF ANY <br /> OTHER STATE OR LOCAL L�.W REOULAT;NO CONSTRUCTION OR THE <br /> Merrill Creek Gardens D1V. 1 PEf1FORAlANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER CF THIS !'ROPERTY TO PERFORM THE WORK FOR WHICH <br /> III APPLICA'fiON IS MADE AND I COMPLY WITH THE STATE <br /> PAqCELTA%I.O.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />� Select janes, In/c.q�,�f//J� � q <br /> CONSTRUCTION LOAN LENOER,AOURESS.TELEPHONG NUM9ER XBV• �G�-L�/. v(d l.f�V( j-2 Z�/5 <br /> O✓1 Q SIGNAIURE OATE <br /> CITY BUSiNE55 UCENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDI.G UNITS—H.P. �— <br /> 7, BATHTUB � 1 FORCEDAIfiSYSTEMS—B.T.U. M E.A.� � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> Q SHOWER � UNITHEATERS—B.T.U. M � <br /> 1 KITCHEN SINK 8 DISP � 1 CLOTHES DRYERS i <br /> 1 DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � 1 RANGE HOOD ; <br /> 1 CLOTHES WASHER i WATER HEATER i <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) �— <br /> i <br /> BACKFLOW PREVENTERS � GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING � � <br /> i - EXHAUSTFAN i <br /> � � <br /> � � <br /> i � <br /> _ � _j � <br /> _ SUBTOTAL $ , � SUBTOTAL $ %� <br /> PERMIT $ i PERMIT $ � <br /> TOTALFEE 5 � TOTALFEE $ � <br /> FOR UFFICE USE ONLY: <br /> FRON�ETBACK / REAR SE-�/ � SIOE SETB�CN t� PLAN CIIECI$,NU�ER. FEE NECEIPT NO. � <br /> ��'_ / /C// /� : <br /> �� �d d Y S ✓.� %��' ',.�' <br /> usez v� �or�nEA_ VACANTSITE FEES VALUATION FEE <br /> 7 CIYES ❑ NO BUILUING (� oz� `�l 7 � <br /> J <br /> HEIGIIT LlMlip OH/ UNI SF OYlELLINO S�ZF OF 9LOGlCI � <br /> Z �(>D�L SF �' p�UMBING 7 � <br /> ZS S GaRaGE 7/ ' <br /> OCCUPANCY NO.OFSIOPIES OCCUPANTlOAD BASEMENT MECHpNICAL �l') <br /> GROUP <br /> R,-3 �s n No — <br /> FIREPLAOIAREO'U (IEASON /1D�I110NAlPLANq1ECK j <br /> � OTHEO /� <br /> FIRE SPfiINKLEF REO'� qEA50N <br /> '� STATE BUILUING SUPCHAf1GE � i%) <br /> TYPEOFCONST. PLMISAPPR VED9V / <br /> CITY OF EVERETT �uoucwonKs �v ; <br /> I� LOCALSALES , <br /> �—/�l onle S /ZS��S TAX CODE IS 3105 707AL �l� j l�rC) <br />