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APPLICAAN FOR CONSTRUCIRON PERMIT <br />CITY OF EVERETT P BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 257.8810 4Z77- <br />7- <br />DEMOLITION ❑ COMBINATION fd BUILDING • ❑ MECHANICAL D PLUMBING - slr.N <br />PROJECT ADDRESS -N- <br />)WNE. CAILADDRESS CITY EPA PHONE <br />RAIDW EW4 LLC• 11032 1S^'KJDA SE _ 6fb I °1G012 Ili:- 7113•/`IIY <br />TENANT CAILADDREss Gn IP PHONE <br />ARCHITECT OR DESIGNER <br />NARADDRESS <br />CITY <br />IF, <br />PHONE <br />_14Owl< DoN <br />A"IIY 6k„'WEa.NE <br />YY1L.rHfvil� <br />c1&270 <br />0•bSR'•33U2 <br />GENERAL CONTRACTOR <br />uUI ADOPESS <br />CITY <br />ZP <br />PHONE STATE LCENSEI <br />(adar P-yr1 LLL. <br />11032 3Sf' la yr SF <br />1304tAcll <br />y8ull. <br />',IS•-7V;•I7/y <br />CECHANICAL CONTRACTOR <br />CAT. ADDRESS <br />C:tY <br />ZP <br />PHONE StAiE LICENSE • <br />&V Force 1ti42, lb" 4vc• 11WI <br />WlGrrsu,ll( <br />9827/ <br />Sbo-W2-Li ZF <br />PLDHBING CONTRACTCR <br />ww nll,Lmkiia <br />WILAODIESS <br />Ion Il AIS414w. <br />CITY '^ <br />Ne Uk Wf.i <br />1 <br />ZIP <br />JYWL 4a9Yz <br />_ <br />PHONE STATE LICENSCA <br />?LA.L71 AE/AY <br />CONTRACT PACE of W ORA <br />—� <br />HEATING SYSTEM; ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AND PHONE NO <br />LL 2' a 14/ <br />DESCRIBE WORK AND SOVAAE FOOTAGE vn0.VE0 <br />SFR 16q <br />(—54c- I L-0 <br />PROPOSED USE OF B W WING <br />S F <br />1 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 g0E5 NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OF <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 15 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br />X /j( / 7 ISfOZ- <br />LEGAL DESCRIPTION OF PROPERTY ISnOwN BELOW CA ATTACH TWO COPIES( <br />LOT � BLOCK a< <br />de. L.: AA AC LYK -i4 <br />PARCEL TAA I D NVUBER <br />CO�N�StRUCTGx OAN IE OER ADORE S. iE1 EPnONE xUUBEP <br />I'IoWil, aAn Z O b• b2 3 Sob o <br />SIGNATURE CARE <br />r�zlozrp, <br />IIrr•• <br />2000 TWO UNION SUR.ri W1 Uh:(Yl S4rt <br />CITY BUSINESS LICENSE IG. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLO._T(TOILET) <br />O <br />AIC— A/HNDLG UNITS <br />I <br />BATHTUB <br />i <br />FORCED AIR SYSTEMS <br />L) <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />2 <br />1 SHOWER <br />1 <br />O <br />UNIT HEATERS <br />I <br />KITCHEN SINK It DISP <br />I <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE MOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER _ <br />WOOD STOVE <br />O <br />URINAL <br />Q <br />1 METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD SURNIIIG) <br />FLOOR DRAIN <br />_ <br />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />I <br />II <br />GAS RANGE. <br />SINK (SERVICE —BAP, ETC.( <br />GAS PIPING <br />— <br />EXHAUSTFAN <br />SUBTOTAL $ <br />SUBTOTAL S <br />- <br />PERMIT S <br />PERMIT S <br />O TOTALFEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />()IA) 'kJl -OOL/ <br />FRONT SETBACA <br />aD <br />REAR SETBACK <br />Fay <br />SIDE SETBACK <br />S <br />P CHECK HUUBFR <br />� ) f p I -o07 <br />fEE <br />RECEIPT NO <br />,BE IDNE <br />/ <br />LOTAREA <br />// 3710 <br />VACANt5RE <br />�rss D No <br />FEES <br />VALUATION <br />_ <br />FEE <br />BVADRni <br />/p ZO <br />.EOHI IIwAFgr. <br />O/ <br />No Of CYCILR9 <br />.ITS <br />SIIE Of BLDWI <br />7 2 S <br />RUING <br />aC.'ANDY <br />)J. <br />NOG fiOPEf <br />OCCUPANT LOAD BASEMENT � <br />OYES O'FIO <br />DECIANCAL <br />ADDITION-L PLANCnECK <br />IRE PPgALER REGO <br />REASON <br />'OTHER <br />F..E A".. AEG <br />PEASOII <br />STATE BUILDING SURCHARGE <br />,.PC OF DOKBT <br />PLAxSAPPxov[Der <br />DAZE p Z <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />