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APPLICATIL A FOR CONSTRUCI.ON PERMIT OfZ77 <br />CITY OF EVERETT • BUILDING DIVISION <br />:3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />i I DEMOLITION I COMBINATION 4A BUILDING MECHANICAL fl PLUMBING SIGN <br />PROJECTADDRESS <br />OWNER ,� MAILADDRESS <br />CITY <br />DP <br />PI/ONE <br />re.f 1-Kny/ae.T ,tce� <br />T <br />1367.63.4 Sf $t <br />SE ev�i( <br />�6'zAY <br />TENANT MAIL ADDRESS <br />Skis/PHONE <br />: <br />CITY <br />ZIP <br />ARCHITECT OR DESIGNER MAIL ADD5E55 <br />,,1' <br />ZIP <br />PHONE <br />RE AL CONTRACTOR MAILADOEIESS <br />CITY <br />ZIP <br />PHONE <br />5TAT 'LICE NSEF <br />uJYJer <br />MECHANICAL CONTMCTOR MAILADORESS <br />fYlU <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMA n CONTRACTOR MAILADDRESS <br />NN <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE L <br />CON J-PRK:E OF WOI1K_ <br />� '"4cv 6 J <br />HEATING SYSTEM: I l GAS [!ELECTRIC f <br />DE"BE WORK AND SqUARE FOOTAGE IWqIVEq <br />CONTACT PERSON AND PHONE NO - <br />x 51), = s/o <br />1 p <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />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 />CONTRACTORS /LAW 18.27 RCW AND 296.200 WAC. <br />SIGNREUliE f DATE <br />PROPOSED USE OF BUILDING <br />I • <br />LEGAL DESCI IPTION OF PROPER (SHOWN BELOW OR IT N ME51 <br />LOT 7 BLOCK � <br />1 V <br />- <br />PMCELTAK l o. NUMBER <br />HONE <br />CONSTRUC <br />AN LENDER, ADDRESS, TELEPHONE NUMBER <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYP° OF FIXTURE OR ITEM <br />FEE <br />A <br />WATER CLOSET (TOILET) <br />I—AfT <br />A/C —A/HNDLOUNITS —H.P. <br />, <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />( <br />LAVATORY (WASH BASIN) <br />, <br />7 <br />HEAT PUMP <br />, <br />SHOWER <br />UNITHEATERS—B.T.U. M <br />I <br />KITCHEN SINK d DISP <br />i <br />CLOTHES DRYERS <br />DISHWASHER <br />I <br />VENTILATION FAN <br />, <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />, <br />WATER HEATER <br />, <br />URINAL <br />' <br />WOOD STOVE <br />- <br />DRINKING FOUNTAIN <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />, <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />, <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />, <br />' <br />GAS PIPING <br />I <br />_ <br />I <br />EXHAUST FAN <br />, <br />I <br />, <br />SUBTOTAL d <br />SUBTOTAL S <br />PERMIT S <br />I <br />PERMIT S <br />TOTAL FEE S <br />' <br />TOTAL FEE S <br />; <br />FOR OFFICE USE ONLY: / '4 t'7 &5 <br />FRONT SETBACKS <br />REAR SETBAL ` f <br />SIDE SETS <br />PLANCHECKM ER <br />FEE <br />RECEIPT NO. <br />USEZONE <br />L - <br />LOT AREA <br />VACANT SITE <br />nYES n NO <br />FEES <br />VALUA ON <br />FEE <br />BUILDING <br />C� <br />•7 <br />HEIGHTU TI <br />NO OF DWELLING <br />UNITS <br />SIZE OF BIDORI <br />rowr <br />PLUMBING <br />OCCUPANCY NO Oi BTgLEB <br />GROUPAIJA <br />OCCUPANTLOAD <br />BASEMENT <br />IT YES IV'NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />TIRE ALARM RED <br />REASON <br />OTHER <br />FIRE SPRINKLER REDD <br />No <br />REASON <br />STATE BUILDING SUOCHAROE <br />/ <br />TYPE OF CONST <br />-t`LU <br />PLANS APPPOyE BY <br />CJ[J <br />DATE L,J/-, 95 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />/1 <br />C/ <br />TOTAL <br />