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"S ycAMokF' !M-S Ic <br /> APPLICATION FOR CONSTRUCTION PERIVIIT�* <br /> CITY OF EVERETT A BUILDING DIVISION <br /> CEDAR STREET• EVERETT, WA 98201 A 259.6810 <br /> L7 DEMOLITION fxl COMBINATION IR BUILDING kl MECHANICAL k) PLUMBING 11 SIGN <br /> PROJECT ADDRESS 0 3�� <br /> / 5 � �/. S, I,J. Cvcrr1f <br /> OWNER MAIL AIOREss CITY Ilr PNDI+E - <br /> -Selec HanesF�_12g1]�Bt11 eve. IV MA-20 GIF rg�t,—p �p9�9b/513-9006 <br /> TENANT MML ADDRESS CITY ZIP PIIONE <br /> ARCIBIECT 0175ESO9En MAIL ADDRESS CITY 21P PIIONF. <br /> GENERAL CONTRACTOR MAILADDnESS CITY zip PIIONIF STATE LICENSE IT <br /> elect liam Ing. 12811 8 h Av W. MIL-•?01 ME �]n 98204 7,06/513-9006 SrrFrrTIIOKN <br /> CIIAMCAL CONInACIOn MAILADMESS 7rY tIP PI TONE STATE LICENSE <br /> PLUMBRlOCONIRACIOR MMLADDrIESS CITY zip r110NE STATE LICENSE <br /> CONTRACT PRICE OF WORN <br /> BOUHEATING SYSTEM: d9 GAS ❑ ELECTRIC <br /> BCRI E WORN AND ME FOOTAGE INVOLVED CONTACT PERSON AM PIONF IO <br /> construction of-one sinale feadly residence Pandy Clark 206/513-9006 <br /> Beverly King 206/513-9006 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS , <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Single family liwell PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGA,DESCRIPTION OF PPOPETITY(5110M BELOW On A17ACII IWO COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT. 7� BLOCK, of AUTHORITY TO VILLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE On LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> Merrill Creek Gardens Div. 1 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 /> PARCEL TAX I.D.NUMBER CONTRACTORS LAW 10.27 nCW AND 296.200 WAC. <br /> Select• Ityj]7 s, Inc/.y/J <br /> CONSIFUCRON LOAN LENDER,ADDRESS.7ELEPNONE NUMBER XQV: !`"k .YAC ( 4,1 /J 3199 <br /> O. SIGNAIURE DIE <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE On ITEM FEE <br /> WATER CLOSET(TOILET) 1 AIC-NHNDLG UNITS-H.P. _ �- <br /> 1 <br /> jL BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I 14EAT PUMP _ <br /> 1 <br /> SHOWER I UNIT HEATERS-B.T.U. M <br /> KITCHEN SINK 8 DISP 1 CLOTHES DRYERS 1 <br /> _ DISHWASHER I / - VENTILATION FAN r <br /> LAUNDRY TRAY ) RANGE HOOD <br /> CLOTHES WASHER I WATER HEATER 1 <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN I METAL FIREPLACE(WOOD BURNING) I <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) �— <br /> BACKFLOW PREVENTERS GAS FIREPLACE ' <br /> SINK(SERVICE-BAR,ETC.) I GAS RANGE <br /> ' OAS PIPING _ <br /> 1 EXHAUSTFAN 1 <br /> 1 I <br /> I 1 <br /> _ SUB TOTAL $ ' SUB TOTAL S ' <br /> _ PERMIT S PERMIT <br /> TOTAL FEE $ ' TOTAL FEE $ i— <br /> FOR OFFICE USE ONLY: <br /> rONTSEIBACKJ DEADS SIDE 6EIBACI; PLAN CHECK NUMBEn REE RECEIPT NO <br /> C . <br /> USE ZONE/7�Z/ LOT A"FA y vACANr Re FEES VALUATION FEE <br /> ✓L� ��" ()YES f7 N0 BUILDING <br /> 111510141 IMITAZZb OF DWELLING <br /> f <br /> UNITS <br /> SIZE Or FILDIVT 1. <br /> I1632 J-r I14"✓4 t PLUMBBro <br /> J Sl (:sAJZA46 <br /> O <br /> CCCUPANCY TIO Or STODE ��S OCCUPANILOAD BASEMENT / MECHANICAL <br /> r-� '� <br /> . 2 _ ❑YES IYNO / <br /> FIRE ALARM"TOO REASON ADDITIONAL ROAN CIIECK <br /> 11„ OTIIEO <br /> FIRE SPRINKLER"EGO REASON <br /> �{ STATE BUILDING SURCIMnGE <br /> TYPE OF CONST runser7mo Der CITY OF EVERETT PunLlcwonKs - <br /> N LOCAL SALES <br /> y,J unlE 6 Z��9S TAX CODE 19 3105 107AL <br />