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APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259.8810 <br /> Fl DEMOLITION rl COMBINATION BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> aUPi s�v <br /> OO/W1NERMAIL ADDRESS <br /> ' - ZIP .� PHONE <br /> TENANTjanal 5IL�/ tT((/O Xp�� JG AA6j) IJ;4 <br /> LApDRES PHONE <br /> ry <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> 5oa11L �:• DW",w <br /> GENERALCONTRACT011 i..AILADDPESS CITY ZIP PHONE STATE LICENSE <br /> k -mc C�s (l'w*Ae_v Cvu,NT r-x a 10Il l3 <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSED <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: AS ❑ ELECTRIC ❑ <br /> DESCRIBE_WOfIK AND SOUARE FOOTAGE INVOLV D C NT CT PERSON AND P ONE NO <br /> /YIL��•4'-V1 E 1G 4 <br /> s 6LO, 9103 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> POPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 5 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW qp ATTACH TWO COPIES NOT. THE GRANTINJ OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT 2—BLOCK GF iq'�� L 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 TAX I.D.NUMBER Ss ))Jrj OU 0—QO L ' Cvu 0 CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRESS.TELEPHONE NUMBER X P 3 1 e q <br /> SIGNATURE ,`,;Zt/.2 4 GATE <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) 1 A/C—AMNDLG UNITS—H.P. I <br /> BATHTUB ; I FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I HEAT PUMP I <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> 1 KITCHEN SINK 8 DISPi CLOTHES DRYERS ) <br /> DISHWASHER ' VENTILATION FAN 1 <br /> LAUNDRY TRAY ; I RANGE HOOD ; <br /> CLOTHES WASHER I WATER HEATER I <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN ; I METAL FIREPLACE(WOOD BURNING) I <br /> FLOOR DRAIN ' FIREPLACE INSERT(WOOD BURNING) 1 <br /> BACKFLOW PREVENTERS GAS FIREPLACE ' <br /> I <br /> SINK(SERVICE—BAR,ETC.) I OAS RANGE 1 <br /> GAS PIPING ' <br /> I EXHAUST FAN I <br /> 1 1 <br /> 1 I <br /> I I <br /> I I <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S 1 PERMIT S 1 <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETP^A�CK�I REAR SETBACK SIDE SETBACK. PLAN CHECK NUMB R FEE RECEIPT NO. <br /> USE ZONPR IOT AnpA If 7Tj VACANT BITE FEES VALUATION FEE <br /> ES 11 NO BUILDING 12001.9y7 D <br /> HEIGHT LIMITATION A NO OF DWELLING SIZE OF LppQI T <br /> 2 UNITS I �� fk.0/_ V-j { PLUMBINGsof r <br /> OCCUPANCY I NO OF STORIES OCCUPANTLOAD BASEMENT <br /> GROUP MECHANICAL <br /> / <br /> '3&-1 ❑YES A'NO <br /> FIREALARM RED REASON ADDIRONAL PLAN CHECK <br /> OTHER <br /> FIRE SPRINKLER REO'D REASON <br /> STATE BUILDING SURCHARGE T <br /> TYPE OF CONST PLANSAPPRDyXY CITY OF EVERETT PUBLIC WORKS /7 / <br /> �J� LOCAL SALES <br /> /T/ DATE 3 Ig TAX CODE IS 3105 TOTAL <br />