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APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> -I DEMOLITION ❑ COMBINATION 19,BUILDING ❑ MECHANICAL WPLUMBING 1� SIGN <br /> PROJECT ADDRESS <br /> OWNER �Q�//JJ�� MMLADDRESS CITY IIP PHONE <br /> zo 15 <br /> TENANT MAILADDRESS CITY <br /> jIP PHONE <br /> ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br /> f,EVERALCONTRACTCR MAI.ADDRES CITY ZIP PHONE STATE LICENSE <br /> l�El/ &dnoW Np vSr_ 37//-/22{�/.TS'E, E(/ERETr 9H208 337AD75 r7TEJ!$�2/Z•rR <br /> MECHANICAL CONTRACTOR MNLADDRESS (TTY ZIP PHONE STATE TENSE <br /> PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE (CENSE <br /> CONTRACT PRICE OF WORK -- - — <br /> HEATING SYSTEM: P'GAS ❑ ELECTRIC (7 <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED CONIACT PE115ON AHD PHONE NO <br /> ��E BARr4o w — 337- 90 7 9 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING I�o APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> " <br /> LEGAL DESC WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IPTION OF PROPERTY(SHOWN BELOW OIR TTACH/lrOOOP( I /- NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Lor �- BLOCK �i (A 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 TAA I.D.NUMBER CONTRACTORS <br /> (LAW <br /> '10.,27 RCW AND 290.200 WAC. <br /> Gd/7y ,3A,✓/C N— .ADDRESS,TELEPHONE //_�� <br /> 6#44 gHrEZZ-75 5-5"9 33 5*NATURE DATE <br /> CITY BUSINESS LICENSE NO <br /> rLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) A/C-A/HNDLG UNITS-H.P. T— <br /> BATHTUB / FORCED AIR SYSTEMS-B.LU. M E.A. <br /> ,3 LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER I UNIT HEATERS-B.T.U. M I <br /> / KITCHEN SINK b DISP CLOTHES DRYERS <br /> DISHWASHER VENTILATION FAN <br /> LAUNDRY TRAY ; RANGE HOOD <br /> CLOTHES WASHER I WATER HEATER <br /> URINAL WOOD STOVE <br /> DRINKING FOUNTAIN ) METAL FIREPLACE(WOOD BURNING) ; <br /> -FLOOR DRAIN I FIREPLACE INSERT(WOOD BURNING) <br /> BACKFLOW PREVENTERS ' GAS FIREPLACE <br /> SINK(SERVICE-BAR,ETC.) GAS RANGE �— <br /> GAS PIPING <br /> EXHAUSTFAN <br /> I I <br /> I 1� <br /> I ; <br /> , <br /> SUBTOTAL f SUBTOTAL f ; <br /> PERMIT f PERMIT f <br /> TOTAL FEE f TOTALFEE $ _ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REM SETBACK SIDE SETBACK <br /> PLAN RE <br /> CIIECN NUMBER ) FEE _ CEIPT NO 1 <br /> Cllr' /' 11le X <br /> USE ZONEjun +� LOT AREA VACANT SITE FEES VALUATION FEE <br /> J✓ <br /> /" �/ , OYES ❑ NO BUILDING <br /> HE13HT UWT&tlobL. J <br /> UNIOF DWELLING SIZE OF BLO(YEI. JC'1LL 'YS L, 00 <br /> UNTS I V yU 5 f l_1 u;u f PLUMBING <br /> S'n S G:nr, UD <br /> OCCUPANCY NO Of STOREY OCCUPANT LOAD BASEMENT <br /> GRof-2, DYES MECHANICAL "(_Z CO <br /> LL ISI &40 <br /> FIRE KtQ'U REASON ADDITIONAL PLAN CHECK <br /> C OTHER <br /> FIRE 6PWIAKLEp REDD REASON <br /> O STATE BUILDING SURCHARGE <br /> TYPE OF, PlAN9APPP0 EDGY CITY OF EVERETT PUBLIC WORKS <br /> _IJ � � ) LOCAL SALES O;1 ZOn <br /> DATE 2 i /, TAX CODE IS 3105 TOTAL c.-�'� <br />