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APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EE • BUILDING DIVISION <br /> 3200 CEDAR STREEETT I,•EVERETT, WA 98201 •259.8810 <br /> Fl DEMOLITION fl COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGH <br /> PROJECT ADDRESS <br /> OWNER MAIL ADORESS CITY ZIP PHONE <br /> uvcubd {Jrmct /yUlo NAA,4, p c,.,t, arsv sat In 4 <br /> TENANT MAIL ADDRESS CITY ZIP <br /> PHONE <br /> ARCHITECT DR DESIGN ER MAIL ADDRESS CITY ZIP PHONE <br /> GEkf L lli IA M!1/ <br /> GENERAL CONTRACTOR MAILAODRESS CITY ZIP PHONE STATE LICENSE• <br /> 1rh me C� i.Mtr1�y COLI NT=4E 9 1 o"a <br /> MECHANICAL CONTRACTOR MAILADORESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY Z:. PHONE STATE UCENSE0 <br /> CONTRACT PRICE OF WpnK <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED C NT CT OERSON AND P ONE NO <br /> ¢ ("y •A4/stl <br /> _ 5� Z6k3_ <br /> I I 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 /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL CRIPTIONOFPROPERTV(SNOIVNBEL AnecHTwocoPlE l WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK OF' M > - ' 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 /> PARCEL TAXI .Nu Em - CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> - U o a Joe'3 • Lk)0 LT <br /> CONSTRUCTION LOAN LENDER,ADOAE95,TELEPHONE NUMBER X D4lv„L Q 4l"_b I_ <br /> SIGNATURE ,\ ^ DATE <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> "JT WATER CLOSET(TOILET) 1 AIC-AMNDLG UNITS-H.P. --�— <br /> BATHTUB ' FORCED AIR SY"TEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I HEAT PUMP , <br /> SHOWER ' UNIT HEATERS-B.T.U. M 1 <br /> I KITCHEN SINK 8 DISP i CLOTHES DRYERS ' <br /> DISHWASHER 1 VENTILATION FAN , <br /> LAUNDRY TRAY ; RANGE HOOD 1 <br /> CLOTHES WASHER I I WATER HEATER , <br /> URINAL WOOD STOVE 1 <br /> DRINKING FOUNTAIN I METAL FIREPLACE(WOOD BURNING) , <br /> FLOOR DRAIN FIREPLACE INSERT(WOOD BURNING) 1 <br /> BACKFLOW PREVENTERS GAS FIREPLACE ' <br /> SINK(SERVICE-BAR,ETC.) I GAS RANGE , <br /> ' GAS PIPING 1 <br /> EXHAUSTFAN , <br /> I 1 <br /> ) I <br /> I � <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT $ , PERMIT S_ I <br /> TOTAL FEE $ TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK READ SETBACK SIDE SETBACK PLANCHECg%DMBEq� FEE RECEIPT NO. <br /> USE ZON LOTAnFA VACATSS TE FEES VALUATION FEE <br /> �- I YI T'ES Cl NO BUILDING -�" <br /> HEIGHT LIMI�TION NO OF DWELLING SIZE OF BL00 .I <br /> 8 uNns —_ 3 F. L RA.Yy t M 30 11 <br /> PLUMBING <br /> OCCUPANCY NO OL STORIES OCCUPANTLOAD BASEMENT MECHANICAL , <br /> GROUP w <br /> L I,, ❑YES KNO <br /> FIRE ALARM RED REASON ADDITIONAL PLAN CHECK <br /> FIRE SPRINKLER TIED REASON OTHER <br /> STATE BUILDING SURCHARGE <br /> TYPE OF CONST PLANS APPROVEDBYBY CITY OF EVERETT PUBLIC WORKS /l <br /> — 1 LOCAL SALES o <br /> DATE ( 9!o TAX CODE IS 3105 ITOTAL <br /> r <br />