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--�. ,-. <br /> ���r ` APPLICATI��N FOR CONSTRUC'. �ON IPERMIT <br /> �'i P6 CITY OF EV[RETT r BUILDING DIVISION <br /> 3200 CEDAR .STREET• EVERE7T, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ pLUMBING ❑ SIGN <br /> PROJECTADDRESS: I010� �IN Aai�E S� ���IQEfY L1/A ��aaQ� B�►�o�r'6 ! <br /> M�ueRovk f�CCec1�I , LLG loi�� `h� Ave, s�, e��ReTr 9Saca 3y;-Ybs7 <br /> ER �RA'JD ESS C�iY 7iP �HONE <br /> NoN� <br /> IENANT M�II�pD��F.55 CItY )iP PuONE <br /> \� �� <br /> Rlck ANOERSor1 ilNl A AVenlv� EoMoNoS WA `l�oao 2ob - 77$-`�0$s <br /> ARLNITECTORDESIGNER MuIADORE55 GIN 71P n110NE <br /> B Ro�$.-�sa-c L�c 0 0 - ve •�_. Ev��2 'ao 3Y -46s7 M(u.B A��ssPP <br /> GENERMLONiO�CTOR MNLADO E55 f.11Y 71P PnONE GfAIEI�CENSE� <br /> RELIABLE . E�T MtiTA� 114ti'�- I�oTN NE kiRkl�o A `iPn33 266 8�•3 6R1,� REt� sM�4SLF <br /> MECHANICALCONTRAC70R �IUDORE55 Cltt ZIP ���ONG StAtF.LICENSE� <br /> o��Nsar� P�uMgt�ll�yl��s� 6vEKErr M�u-�+ay �ad �ve�rr 9RaaQ �S.s�-6I7r RoBiNfl�a�c� <br /> LUA�BINGLONiR6CTOR MAII,ApDFESS Cltt ZIP PNONE STnIELIGENSE� <br /> CpJiRALT VR�GE OF WORK <br /> � I O 0 , NEATING SYSTEM: J�GAS ❑ ELECTRIC ❑ <br /> OESCRIBE WORK�ND SOUARE FOOTACE INVOLVEO CONinCf P�RSONAND PHONE NO <br /> ui u �a � 6 6 R� n�D 3u7 - �.- <br /> �I� � �cc /(3� _ <br /> I HEREBY CEiiTIFY THAT I HAVE READ AND EXAfr11NED THIS <br /> APPIICATION AND K�JOW THE SAME 1'O BE THUE AND CORRECT ALL <br /> . PROPOSED USE OF BUILDIN PROVISIONS OF IAWS ANO ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITH WHE�fHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY(SHOWNBEL W NTWOCOPIES NGT. THE GRAIJTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocrc oF AUTHOFlITY TO VIOLATE OR CANCEL THE PROVISIOPI OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> E�, ( - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERT`/ TO PEAFORM THE WORK FOR WHICH <br /> APPLI ATION IS MADE AND I MPLY WITH THE STATE <br /> OMCEL TAX I.D.NUMBER CO A ORS LAW 18.27 FCW AND 6.200 WAC. �..- <br /> 3970-�00- vig- oa�g (/�� �j <br /> LONSTPUCiION LO�N LENDER,ADDRE55.TELEPMONE NUMpER V\ (" �O� <br /> �S� - .T O S G TUPE ��TE <br /> IO pQD � p'� �� +�SSO ��,!-vE OO CItY BUSINE55 UCENSE NO. <br /> PLUMBING MeCt#ANICAL <br /> NO. TYPE OF FIICTURE OR ITEM FEE NO. 7VPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � �-e- A/C—A/HNDLG UNRS —T <br /> BATHTUB � FORCED AIR SYSTEMS ; <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS ' <br /> KITCHEN SIN�S DISP � CLOTHES DRVERS � <br /> DISHW.AS��ER � 'a RANGEI100D � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> .Q- URINAL ' MEfAL FIREPLACE(WOOD BURNING) ; <br /> DRINKING FOUNTAIN i -B- FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVC•NTERS � -�- GAS RANGE i <br /> SINK(SERVICE—BAR,ETC.) � GAS P�PING � <br /> � EXHAUSTFAN <br /> � <br /> i � <br /> � ' <br /> SUB TOTAL E ; SUB TOTAL E ; <br /> PERMIT S i PEFMIT S � <br /> TOTALFEE S ' TOTALF[E 3 ' <br /> FOR OFPICE USE ONLY: <br /> iRONTSETBACK REAfISF.iB�GN SI�ESFTOACN �LAN�II@CNNUMp�fl �Ef �EC[IP1N0 <br /> a�ac� 30 _ <br /> USE ZONE ior�nen ��C�Ni SIIF FEES VALUATION FEE <br /> — ❑VES ❑ NO p��ILNNC. QQ bs 2 � / ��_L� <br /> HEI4MT LIMIT�TION NO OF DWEIUNG 512E O�9LDG I �� ' <br /> ur+irs 276Z .S��F. l�.l��.lU� riuunwc �p� <br /> 7 2 SF. CoARA4�. L�7---�-i- <br /> OCCUPANCY NO(1i SIOPIES OCWPANf L040 BASEMENi MFGInNIf.AL `y <br /> GROV _____ - <br /> �_� J_' r1 ❑YES NO ; <br /> �� — �pp1IlONALPIANC��fCR <br /> FIRESPRINKLEP`iE0'D fiEASON <br /> ��_�.�- <br /> _ � <br /> on�en <br /> Fweannrnneo�o nen�or+ <br /> sure ou�ioiNn sunc�innr,e <br /> rvvEOFr,or+sr r�nNSerrnovePoy CITVOFEVERETT runnr,wonKs __��� <br /> �J}�" LOCAL SALES --- -- -- <br /> �/..� oAiE c���3 C7'� TAX CODE IS 9105 7o7A1 ___ _ _ <br />