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APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION <br /> 3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br /> 1 DEMOLITION ❑ COMBINATION )C.BUILDING ❑ MECHANICAL )W PLUMBING I I SIGN <br /> PROJECT ADDRESS ;J <br /> OWNER MAILADDRES6 <br /> CITU ZIP PHONE <br /> TENANT /1��� MAILADDRE65 <br /> CRY ZIP PHONE <br /> ARCHITECT ORDESIGNER MAIL ADDRESS <br /> CITY ZIP PHONE <br /> OENERALCONTRACTOR MAIL AGGRESS <br /> ✓EN 94dZ c CITY Z'P PHONE STATE UCENSE <br /> W LIO/✓Sf 37//-/221PL,.S'E, EVERETT °f8Zo8 337AD7g oreyes-42 <br /> A'ECIIM,CrL CONTRACTOR MAI ADDRE 56 <br /> CITU ZIP PHONE STATE LICENSE I <br /> PWMBINOCONTRACTOR uALADDRESS <br /> C'TM DP PHONE STATE UCENSE• <br /> CONTRACT PgICE OF WORN <br /> HEATING SYSTEM: $rGAS O ELECTRIC ❑ <br /> UE SCRIBE WORK AND SWARE FOOTAGE INVOLVED <br /> CONTACT PERCON AND PHONE NO -- <br /> KVr BWRr o w — 337- 90 7 9 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PRO POSED USE OF BUILDINGG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> x PROVISIONS CF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DE'SCCRIP"TION OF PROPERTY IbNOWN BELOW OR ATIACH TWO COPIE:iI �WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT�`BLOCK -^L w'/'c//C CO tOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO CIVE <br /> Or E R0 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> V/L/ T OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%LD.NUMBER CONTR,.CTORS LAW 18.27 RCW AND 296.200 WAC, <br /> COy STRUC110N LOAN LENDER,ApppESS,TELEPHONE NUMPER <br /> ✓lC — l//LJ NEEHAN-7'/55933 SIGNATURE <br /> DATE <br /> CITY BUSINESS UCENSE NO. <br /> PLUMBING <br /> MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM <br /> OT) FEE <br /> WATER CLSET(TOILE <br /> BATHTUB , <br /> VC—A/HNDLG UNITS—H.P. <br /> 3 LAVATORY(WASH BASIN) FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> SHOWER ' HEAT PUMP <br /> / KITCHEN SINK 8,DISP UNIT HEATERS—B.T.U. M <br /> DISHWASHER ' CLOTHES DRYERS <br /> VENTILATION FAN T— <br /> LAUNDRY TRAY <br /> CLOTHES WASHER RANGE HOOD <br /> ' I WATER HEATER <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN I FIREPLACE INSERT(WOOD BURNING) <br /> BACI(FLOW PREVENTERS GAS FIREPLACE <br /> SINK(SERVICE—BAR, ETC.) OAS RANGE <br /> GAS PIPING <br /> EXHAUSTFAN <br /> I <br /> I ; <br /> I T <br /> ----------- <br /> SUBTOTAL S SUB TOTAL $ ' <br /> PERMIT $ PERMIT S <br /> TOTAL FEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT 6ETDAC j REM 6ET6ACK I`, BIDE 6ET8.4;K / PLAN CHECK NUMBER FEE 7 RECEIPT N0. <br /> USE ZONE T / <br /> LOTAREA _ -7 VA:ANi A E FEES VALUATION FEE <br /> .� L3 / DYES D NO <br /> HEIGHT UMIIATI ry_ NO OF DWELUNG SIZE OF PLOO�fI BUILDING <br /> 2-1MO <br /> UNITB Tb iJ $I, C rvw / <br /> SOY SF Ci AA'AL:c PLUMBING <br /> OC p U� NO.OF STORIES OCCUPANT LOAD GJ <br /> BASEMENT MECHMICAL <br /> ' Z N /1 DYES r0 <br /> FIRE REq'D !. . REASON ADDITIONAL PLAN CHECK <br /> p <br /> FIRE SPRINKLER REO'0 REASON OTHER to m> <br /> T ,' STATE BUILDING SURCHARGE J <br /> TYPE ONCONST. PLANSAPPROVE BY I•S� <br /> w CITY OF EVERETT PUBLIC WORKS <br /> J I LOCAL SALES - 00 <br /> -IJ DATE 2 7 'i S TAX CODE IS 3105 TOTAL 77 �� <br />