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APPLICATR A FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT I BUILDING DIVISION <br /> 32n0 CEDAR STREET I EVERETT, WA 98201 •259.8810 <br /> 1-1 DEMOLITION I I COMBINATION lt�l UILDING I I MECHANICAL I PLUMBING I I SIGN <br /> PROJECTADDRESSN 9 <br /> 1 <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> l�i�#,E Pf11i('r ZII� (ol Sr S r C�'VCT2[Tl --- <br /> TENANT / MMLADDRESS CITY IIP PHONE <br /> ARCHITECT on DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERALCC�C OR MAILAODRESS CITY ZIP PHONE STATE LICENSE <br /> 7�LvN+ o wT-V�l t6ej;Z1 �0l r't? i4dMOOD "IIW37 X43 /c- 7VI Pr-0I9LT <br /> MECHANICAL CONTRACTOR VAIL ADDRESS C37 ZIP PHONE STATE LICENSE <br /> PLUMBI OCOyTRACTOR MAILADDRESS CIT' ZIP PHONE STATE LICENSE IT <br /> CONTRACT PRICE OF WORK <br /> I/ `149 r HEATINGSYSTE OOAS OELECTRIC <br /> DE IBE WORK AND SOUARE FOOTAGE INVOLVED _ CONTACT PERSON AND PI <br /> 0 C C o,•I OF A Pe LE gcDG q .X - (5 <br /> fe, d S ff <br /> S3� <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 CF URDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> AIL-P, t;- L WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW GRA ACy TWO COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> IVC-0V/LSl" OVA AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> Lot s- OF OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> Lvl I� .11J PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED B1' (HE <br /> ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> I APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARJE�AX L BER o O O, /1 O O O CONTRACTORS LAW 1 8.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION AN LENDE_il.ADOitESS.TELEPHONE NUMBER <br /> iA- <br /> y1z415y <br /> ({- LONA RE — DATE�— <br /> 1 CITY USINESS LICENSE NO. <br /> PLUMBING OHANICAL <br /> •,,( NO. TYPE OF FIXTU E OR ITEM FEE NO. TYPE OF IXTURE OR ITEM FEE <br /> 1 WATER CLOSET I A/C—AIHNDLG'UNITS—M.P. ' <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH B IN) I HEAT PUMP;' ' <br /> SH ER ' U IT HEAT RS-B.T.U. M ' <br /> I ::#KITC N SINK 8 D P ; CL THES' N FAN ' <br /> DISHWA ER I VENTILATION FAN ' <br /> LAUNDRY AY i RANGE HOOD I <br /> CLOTHES WA R I WATER HEATER, ' <br /> URINAL ' W006 STOVE <br /> DRINKING FO NT ' MET L FIREPLACE( D BURNING) 1 <br /> FLOOR DRAI ' FIR PLACE INSERT(WO D BURNING) ' <br /> ' G FIREPLACE <br /> BACKFLOWJREVENTERS I <br /> SINK(SERV .E-BAR,ETC.) G S RANGE ' <br /> ' AS PIPING <br /> XHAIIST FAN ' <br /> 1 ' <br /> 1 <br /> I <br /> 1 <br /> I <br /> SUB TOTAL S ' SUB TOTAL $ i <br /> PERMIT $ I PERMIT $ ' <br /> TOTALFEE $ ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SFTRACAK SIDE SETBACK PLAN CHECK I� FEE �• RECEIPT NO. <br /> �' s USE zo LOT AREA VACANT SITE FEES VALUATION FEE <br /> O YE5 JO <br /> —Z L��j Y" euLONo 2�! <br /> HEIGHT LIMITATION, NO OF DWELLING SIZE OF RUCKMI <br /> UNITS I cicilt C PLUMSING <br /> OCCUPANCY NO Of STMES OCCUPANT LOAD BASEMENT) �� MECHANICAL <br /> OYES MNU <br /> ADDITIONAL PLAN CHECK <br /> FIRE ALARM REOD REASON — <br /> 0711ER <br /> FIRE SPRINKLER PEGD REASON <br /> STATE BUILDING SURCHARGE <br /> _ 1 <br /> TYPE OF CONST <br /> PL <br /> CITY OF EVERETT Pusucwoms <br /> Q q LOCAL SALES — <br /> DATE S a I T CODE IS 3105 TOTAL <br />