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APPLICATILA FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ,� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: _ 2-76a 5? -A S7, S.N <br /> ," A1u. M61.44E0. 2702 soo-itt si s w Evee.R s7 wA 19M 2o` 344 1 ,40 <br /> OWNER ` ESS CITY ZIP PHONE <br /> TENANT V L MMlMAIL ADDRESS CITY ZIP PnONF <br /> Fara R . <br /> —I It -1 SLs pstE rl � s4 s6o �79 440(0 <br /> ARCHITECT OR DESIGNFn AIV L ADDRESS 71P rM)NF <br /> /��psunc Wopin,, 14mi1 7Sr S��(t.t� yup �4�2�3.��4�L AyrN61—919M- <br /> MAIL CONTMCidi MAIL ADDRE 5; CITY 71r TNIONI. STATE LICFNSE9 <br /> MECHANICAL CONTRACTOR �MAIL ADDRESS CRY 71P PHONE 9TATF IICFNSEI <br /> r1AwArf0i — <br /> mt <br /> i /TMAB <br /> OdESS CITY PIONF STATEI.IC(NSF• <br /> s'ss, oo0 <br /> 2Il95) <br /> CONTRACT PRICE OF WORN <br /> HEATING SYSTEM: ❑GAS q ELECTRIC ❑ <br /> DESCRIBE 1V011K ANDSWARE i001AGE INVOLVED CCATACI PfFlSONANDPI f <br /> r O //n/ <br /> -' ' / <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED USE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> S1114LL[ F►tM Aws-. WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN 6ELOWOR ATTACH TWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK Or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> ,.1 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 2 5 9 TJ` A S.W. PERFORMANCE OF CONSTRUCTION.THAT 1 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 T I D NUMBER CONTRACTORS LAW 18 27 RCW AND 296.200 WAC. <br /> X02 7-onn <br /> CdIw4�O(� <br /> ENDER -rill . 14 rq9&PX' URE <br /> DAIS <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AA INDLG UNITS <br /> BATHTUB ) FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) I HEAT PUMP <br /> SHOWER I UNIT HEATERS <br /> KITCHEN SINK 8 DISP CLOTHES DRYERS <br /> DISHWASHER RANGE HOOD ' <br /> LAUNDRY TRAY ' WATER HEATER i <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS GAS RANGE <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> EXHAUST FAN <br /> I <br /> SUB TOTAL S to SUB TOTAL S <br /> PERMIT $ I PERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> ERONTSF TFIAC - i/ AFAR SETBACK SIX SFTBACk PIANCIIECK NUMnfn EIF ,^D RFCFIFFNO <br /> USE ZON LOT AREA VACANT SITE FEES VALUATION FEI-+-- <br /> 'J <br /> (]YESU NO nunnwc 'Q ' <br /> ((EIGHT LIMITATION NO OF OWELLING SIZE Of BLMI I I <br /> '7 Q IINIIS I L y Y S/. �MN. PLUMBING <br /> OCTbCOmANCY NLI(M SIMS OCCUPANT LOAD BASEMENT MFCHANIGI -- <br /> ❑ <br /> ADDIIIONAI PI AN CHECK <br /> FIRE SPRINKLERNEOAF ASON'D _— --�- <br /> DIIIfEi i <br /> TIRE AIMM OFOD RF A5D11 — i <br /> STATE BAIL DING SUACHAOn[ (•"lam/ / <br /> lY1•F Of rCINST r1ANSAPrJVFD BY CITY OF EVER ETT Pt WOnKS ' <br /> J y LOCAL SALES --- - ' <br /> DATE 3 ,f✓' TAX CODE IS 3105 TOTAL <br />