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APPLICATILA FOR CONSTRUCT .ON PERMIT , <br /> CITY OF EVERETT • BUILDING DIVISION <br /> DEMOLITION PS <br /> 3200 CEDAR STREET• EVERETT, WA 998201 •259.8810 n <br /> I I COMBINATION INIBUILDING IK MECHANICAL f�PLUMBING I I SIGN <br /> PROJECT ADDRE _ <br /> E'UERE Lcm <br /> OWNERMAILADDRESS TTI <br /> cIry zm PHONE <br /> TEc J <br /> 32z Tp DI9� SAP. 5 <br /> VONNGluf;�IDMDRESS �Cz <br /> ec• 37-35-7-& <br /> ARCHITECT OR a7l(INER MAILAWRESS CITY• <br /> nr <br /> wfLCN Ic CAU.ILL U�TioJ. - It, 63_ /)C, �� PHONE <br /> OENEqucoNtRACTOR MAILADRnSS CITY �, IIA4 2C.14033o7-3c �2LCN21K7G <br /> IIP rHONr STATE LICENSE F <br /> MECNAIM.AL CONTRACTOR MAILARDRESS CITY <br /> Lr PHONE STATE LICENSE F <br /> PLUMBINGCONTRACTCF MAIL ADDRESS C7TY <br /> IIP PHONE STATE LICENSE r <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: P 16AS 17 ELECTRIC Fl <br /> DESCRIBE W,-Nu SOUARE FOOTAGE INVOLVED CONT CT PERSON AND PHONE NO <br /> SF �DSr1� wL`LtH 33 7 �S7 Q <br /> y ® o <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 1ROPO5EO USE OF BUILDING APPLICATION AND KNOW THE SAME TO BF TRUE AND CORRECT ALL <br /> 5 F PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DES( IPRON OF PIIOPERIY SHOWN BELOW ORATTACH IMCOpIESU WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LOTO BLOCK Fie j(,L C NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> OF OGI AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.i HAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> /c� APPLICATION IS MADE AND I C MPLY WITH THE STATE <br /> PARCEL TAXI D NUMBER CONTRACTORS LAW 18.27 RC_WoAN,D`286.200 WAC. <br /> CONSTRUCTION LIAN LENDER,ADDRESS,TELEPHONE NUMBER <br /> LJ.yel L MD Vat A e t e P -775-5'16Z 6 SIOnaURE ��AAJ/ �7`_yl/ <br /> DATE <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING <br /> NO. MECHANICAL <br /> TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) FEE <br /> A <br /> BATHTUB I IC—AMNDLG UNITS—H.P. , <br /> ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) , HEAT PUMP <br /> SHOWER <br /> ' UNIT HEATERS—B.T.U. M , <br /> I KITCHEN SINK d DISP ; CLOTHES DRYERS <br /> DISHWASHER VENTILATION FAN I <br /> LAUNDRY TRAY ; RANGE HOOD , <br /> CLOTHES WASHER <br /> ' WATER HEATER T <br /> URINAL ' WOOD STOVE , <br /> DRINKING FOUNTAIN , METAL FIREPLACE(WOOD BURNING) , <br /> FLOOR DRAIN I FIREPLACE INSERT(WOOD BURNING) , <br /> BACKFLOW PREVENTERS ' I GAS FIREPLACE , <br /> SINK(SERVICE—BAR,ETC.) , OAS RANGE I <br /> ' 3 GAS PIPING , <br /> ' EXHAUST FAN T <br /> SUB TOTAL E ' SUB TOTAL E ' <br /> PERMIT S , PERMIT E <br /> I ' <br /> TOTALFEE E ' <br /> FOR OFFICE USE ONLY: TOTAL FEE E <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FE RECEIPT NO <br /> I ' I s s a-0 io (.I7(oo3 3s .�s 2.3y1& <br /> USE- LOT AREA VACANT SITE FEES <br /> Z VALUATION FEE <br /> 6S7 Y" UrTfl NO BUILDING7i3 <br /> NEIONT GMITATION / NO OF DWELLING SIZE OF BLDORT Obs V <br /> ? UNITS I 1"o5 f Civ, f- <br /> PWMBING <br /> G <br /> RCU^ANCY NO aSIpOC3 OCCUPANT LOAD BASEMENT <br /> "'3 1 N/A F1YES r6/ MECHANICAL <br /> FIRE ALARM RED REASON ADDITIONAL PLAN CHECK <br /> FIR'SPRINKLER REG'O REASON OTHER <br /> STATE BUILDING SURCHARGE <br /> TYPE OFCONST PUNSAPrR vfiDer CITY OFEVERETT PUBLIC WORKS <br /> Q N V I'� LOCAL SALES <br /> DATE 3 TAX CODE IS 3105 TOTAL ��7 <br />