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APPLICATIdt FOR CONSTRUCTON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />VLF( I l/ / / V DvMAIL <br />ADDRESS <br />LA1IDDRRE/ESS <br />CITY ZIP <br />PHONE10' <br />/ <br />TENANT� MAIL <br />CITY ZIP <br />PHONE <br />CZC5>C,, / D 4 <br />S6 S?IlCk ( �-W2PtF� 2oHt6N�- <br />,�c64. qcc W"19A.0 40E, <br />--- <br />#zm`�o <br />ARCe _CT D I 4EER r` MAIL ADDRESS <br />TCITY 71P f PHONE <br />�r _ <br />GENERAL CONTRACTOR MAIL ADDRESS <br />/�-- <br />CITY L IIP L.0 <br />I TVA <br />Pr <br />E LICENSE Al <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />/ <br />/ <br />/oftIV <br />C <br />1p- <br />qTF LICENSE # <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />Y Z <br />NE� <br />STATE LICENSE M <br />GD <br />r An .1 I a <br />a-, <br />a <br />CONTRACT PRICE OF WORK <br />'965-8 Goo ��� <br />�- <br />ATIN M: GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SOUAR.E FOOTAGE IN OLVED <br />..c c Roves �uiS f c�titcAif+&lL. <br />,ONTACT PF ASON AND PHONE NO <br />j' J�'ti►�9 Cz����Z3 -lf�� <br />Tbt99X-f44L-- F,sf t Q- S <br />I 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 DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <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 IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X <br />PROPOSED USE OF BUILDING <br />VL — <<-- T o ebb <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK 1^.7 _ OF <br />h4!) -s , Uo(„ , 14 d F P <br />'%A6 ? Co. Wt+,Sf+. <br />PARCEL TAX B I D. NUMR <br />Z- o - O©©--,momq- <br />CONSTRUCTIONLOANLENDER, ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <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 />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />r <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SFTRACK <br />RE A SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />22Q 4( <br />RECEIPT NO <br />USE ZONE <br />LOT Aar <br />/- <br />VACANT SITE <br />❑VES ❑ NO <br />FEES <br />VALUATION <br />_ FEE _ <br />BllII DING <br />HEIGHT I.IMITAT ON <br />WELLING <br />N <br />SIZE OF BLDG/T1 <br />VAizo��; <br />PI UMBING <br />' <br />--- <br />OCCLIPANCCY <br />GROUP bb <br />C.�"oC <br />NO OF $KIRIES <br />OCCUPANT LOAD <br />t%h't <br />BASEMENT <br />❑YES �NO <br />MFCHANICAI <br />-__.-_. <br />ADD]TIONAL Pi AN CHECK <br />------- <br />------- <br />; <br />FIRE S RINKLER REO'D <br />ea__. <br />RFASON <br />t-/1 u6 < <br />OTHER-- <br />i <br />FIRE ALARMREO'D <br />RFASON <br />STATE BUILDING SURCHARGE_ <br />-- <br />TYPE OF CONST <br />V ! <br />PLANS APPROVED BY <br />Ti?� _ <br />DATE `oZ� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBI IC, WORKS__CX <br />_ <br />TOTAL <br />