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APPLICATIliN FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259.8810 <br /> f 1 DEMuLITION 11 COMBINATION I I BUILDING I l MECHANICAL l PLUMBING I I SIGN <br /> PROJECT ADDRESS <br /> /1131 <br /> G /R/ A //1/ MAIL ADnnrs. >L� /^y, <br /> 'Y�l� �- JL- ) // CITY_g� //!/ ZIP <br /> I (/r110NE <br /> TENANT MAIL AIXMESS CITY7 <br /> ZIP PHONE <br /> 75611tECi OR DESIGNFR MAILMORESS CITY• <br /> ZIP rIIONE <br /> GENERAL CONTRACTOR MIILADDnrss C Y <br /> Zlr PHONE STATE LICENSE <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY <br /> ZIP PHONE STATE LICENSE i <br /> PLUMBING CONTRACTOR MAILADORESS -- CITY ZIP <br /> PHONE <br /> STATE LICENSE A <br /> CONTRA <br /> C RICE OF jlj WORK <br /> U) HEATING SYSTEM: �i GAS ("1 ELECTRIC Cl <br /> OESCRIOE WORI(L1N0 SOU REFWT�ETNVOlVEO CUN,T�wTPERS AND P110 <br /> 1 22 ✓✓, <br /> 4%/ 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE LF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> SF/L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDESC PTIONOFPROoER7YISIpWNBELOW OnATTACH TWOCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK DF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> LOCALOTHER STATE OP. <br /> PERFORMANCE OF CONSTRUCT CONSTRUCTION. II AM AUTHORIZED BY THE <br /> OWNER OF THId PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLIICC/1AQTIONJ 15 MADE AND 1 COMPLY WITH THE STATE <br /> PARCEL TAXI D.NUMBER CDNTR/1QiO^ ,) 18� CW 7-{� 90.200 WAC. <br /> �l <br /> CONSTRUCDON LOAN LENDER,ADDRESS.TELEPHONE NUMBERf <br /> X J <br /> SIGNATURE GATE <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF fl%TURF OR ITEM FEE <br /> WATER CLOSET(TOILET) I MC—AIHNDLG UNITS—H.P. I <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN% I HEAT PUMP — <br /> SHOWER <br /> ' UNIT HEATERS—B.T.U. M I <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS <br /> DISHWASHER <br /> LAUNDRYTRAV VENTILATION FAN <br /> I ' <br /> -- I RANGE HOOD I <br /> CLOTHES WASHER I WATER HEATER <br /> URINAL ' WOOD STOVE I <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN ' <br /> ' FIREPLACE INSERT(WOOD BURNING) I <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE I <br /> SINK(SERVICE BAR,ETC.) ' <br /> ' OAS RANGE <br /> ' GAS PIPING I <br /> EXHAUSTFAN <br /> I <br /> I <br /> I <br /> I <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ I PERMIT <br /> $ <br /> I <br /> TOTAL FEE $ ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SE`TBA�K REAR SETBACK SIDE SETBAfK RL AN CHECK <br /> •I� , , CI�ECMBE FERECEIPT <br /> % %(Jh <br /> (' <br /> USE 7AUE IOTA A VACANT SITE FEES VALUATION FEE <br /> 3A _ klYES 11 NO BUILDING Z 473 C Q <br /> HEIGHT LIMITATION Z NO OF DWELLING SIZE Or BLoa�r <br /> 28 UNITS L140 5 t <br /> 2 s G A PLUMBING <br /> OOCUPANCY NO OI S10AIES OCCUPANT LOAD BASEMENT 0 <br /> Gno Ir � MECHANICAL <br /> 3 IYES TR'NO <br /> FIRE ALARM REOD REASON ADDITIONAL PLAN CHECK I <br /> OTHER J <br /> TIRE Sabi RED 1) REASON <br /> a STATE BUILDING SURCHARGE <br /> TYrEOFCONST <br /> PLANS APE�r VE BY CITY OFEVERETT PUBLIC WORKS <br /> N LOCAL SALES <br /> i4-' DATE TAX CODE IS 3105 TOTAL D <br />