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APPLICATIA FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 A257-8810 <br />DEMOLITION X COMBINATION ❑ BUILDING ❑ MECHANICAL 17, PLUMBING F_ SIGh <br />PROJECT ADDRESS 9S01 77y^k S� <br />]WNER uAU A➢NIII/ I Illy IF PHONE <br />-Alk Ad <br />ll�i%` TSt9acssCRI ZIP //?�< .t�.e'/sn�G-i•-iFd33 rlwr 5- 8A27 - �/e80 <br />,(:,...r/; •S1A<./..L'c� <br />.gcNrtEcr oESIGrvER NAIEADDPESS Z cln ZIF TONE <br />/nrpcol/ <br />. i v t <br />RJ111011'CONTRACTOO LWLADDRESS CITY ZIP IvgNE STATE LICENSE• <br />✓ni_ -T- .oii� ./ _-- b/..-_'�-_,✓ i• oA; o,,y_6UiD R _.,/ ,.. 4Y,, .P <br />COWRACTP EDFWORM � <br />HEATING SYSTEM: ❑ GAS 1-1 ELECTRIC ❑ ' <br />DESCRIBE WORN NIO SQUARE F00-GE IINQV[O <br />CONTACT PERSON N10 PHONE NO <br />A, <br />• <br />I HEREOY 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 CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAY! REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOP'ZEU 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�RS LAW IB.2YR AND 296.2 WAG. <br />X • _ -�/ <br />PVOPOB[D USE Oi BUILDIN <br />LEOALOESCPWIIO PROPERTYISNOWNDELOWORAUACH $1CD IESI <br />LOT BLOCK __Of— <br />PARCELTAI <br />i? -e A5' <br />CONSTRUCTION LORI LEADER ADDRESS TELEPHONE NAA8ER <br />DATE <br />CITY BUSINESSUC'1 EIq <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />i <br />ANC-AHNDLG UNITS <br />BATHTUB <br />! <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />! <br />HEAT PUMP <br />SHOWER <br />j <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />I <br />WATER HEATER <br />! <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />( <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE -BAR, FTC.) <br />i <br />GAS PIPING <br />EXHAUSTFAN <br />i <br />1 <br />i <br />SUBTOTAL S <br />! <br />SUBTOTAL S <br />PERMIT S <br />i <br />PERMIT $ <br />TOTAL FEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK T <br />W <br />PEAR SETBACK <br />Z o <br />SIDE SETBACK <br />NECK NUMBER <br />fEE <br />19/ <br />RELEbT NO <br />USE ZONE(�Z <br />11 <br />LOTAREA_ p /. <br />J�j5�1D �Y <br />VACANT SITE <br />❑YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />L�O <br />HEIGHT I MUTATIONA <br />rf p� <br />NO OF DAELLIIA <br />UNNS' <br />SREDFBUIGITI. <br />0 /1•G / <br />PLUMBING <br />�— <br />OCCCC�UIPPANCY4 NO DI I145 <br />-J rtJ�( <br />OCCUPANT LOAD <br />SAS ENT <br />OYESVHO <br />MECHANICAL <br />AppI110H4 PLAT CHECK <br />FOIE SPRINKLER REDD <br />PEAWN <br />OTHER <br />FOIE AUPu RED <br />PERSON <br />STATE IRR DIIX SURCHARGE <br />mPEa COrvsT <br />PLANSAPPPOVED er <br />DATE / <br />CITY OF EVERETT <br />LOCAL SALES <br />TA% CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />