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APPLICATIGA FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259.8810 <br /> 1 1 DEMOLITION I I COMBINATION IN'BUILDING f+�T MECHANICAL I44PLUMBING I SIGN <br /> PROJECT ADDRESS / � A�<)T/I P/ <br /> L <br /> OWNm MAI)ADDIIFSF fRr <br /> c 71P 1'nDNf <br /> "51LcA1 /C W12LL.CA Lg 2 Z]6T N -�L4//pNiLN.�yA, 9b25of 2P6�337-3ste <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY )IP PHONE <br /> GENERAL CONTRACTOR MAILADDPESSCHV ZIP PHONE STATE LICENSE <br /> LLC'LF S COAJ-rr2UC:1•F'PY gW, 6.322 76r"h25a Siyd*m'SN ,1 90Tfi Zui)33?L3S2R Wk(.Ck Z147�t <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY .r PHONE STATE LICENSE F <br /> PLUI.JING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: UPUAS n ELECTRIC ❑_ <br /> DESCRIBE WORKA7 SDUAPEFGOTAGEINVOLVED CT PERSON AND PHONE NO <br /> NSW F2 33 <br /> -3Sz <br /> 1 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 /> S F2 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�JO,R.,,AeTTACH TWO COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> X <br /> LOT 13 BLOCK OFMfL Al CUl"ll C&RA"01 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 10.NUMBER il CO TRACTORS LAW 18.27 R;W AND 290.200 WAC. •'L <br /> CONSTRUCTION LOAN LENDER,ADDRESS.TELEPHONE NUMBER / X <br /> �NA/Woeb ,MDRTGALE1CAOkP 77.6,562 SIGNATURE DATE <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OF ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) I AIC—AMNDLO UNITS—H.P. I <br /> Z. BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> Z LAVATORY(VIASH BASIN) HEAT PUMP <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ) <br /> DISHWASHER ' VENTILATION FAN I <br /> LAUNDRY TRAY ; RANGE HOOD ' <br /> CLOTHES WASHER I WATER HEATER I <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN ) METAL FIREPLACE(WOOD BURNING) 1 <br /> FLOOR DRAIN ' FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) I GAS RANGE I <br /> ' _3 GAS PIPING ' <br /> I EXHAUSTFAN I <br /> 1 I <br /> 1 , <br /> SUB TOTAL $ ' SUB TOTAL S ' <br /> PERMIT S I PERMIT S <br /> _ TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: _ <br /> mONT SETRAC>, PEAR SETBACK SIDE SETBACK PUN CHECK NUMBER FEE U.C' RECEIPT NO. <br /> I� 5 A `1 i63CQ� $ to l _ <br /> USEZONE '�� LOTAREA VACANT SITE FEES VALUATION FEE <br /> — 51916E9 f1 NO BUILDING 75*06 <br /> HEIGHT LIMI•ATION NO OF DWEI LING SIzE OF BLDG/TI <br /> Z� UNITS I 1401 Sf LIVIU4 + PLUMBING <br /> C./ Zo S G�RAcL <br /> OLCUIMNCY Nr ro 90RiE5 Ot CUPANT LOAD BASEMENT - / MECHANICAL <br /> TfB!_C .j fI YES 1104 <br /> FIRENARM'RREEO'D REASON ADDITIONAL PLAN CHECK <br /> R <br /> OTHER <br /> FIRE SP INKLER REOO REASON <br /> N O STATE BUILDING SURCHARGE <br /> TYPE OF CONST PUNS MPR.jr CITY OF EVERETT PUBLIC WVPKS <br /> l� LOCAL SALES <br /> -N DATE S 1l 4 TAX CODE IS 3105 TOTAL <br />