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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT I BUILDING DIVISION <br />3100 CEDAR STREET I EVERETT. WA 98201 1259.8810 <br />❑ DEMOLITION ❑ COMBINATION !Zi UILDING -MECHANICAL N PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 3 -Q-1 e" � e C= U ( <br />lbo(OOL. tLttk ,iN(-L Is.au (o>Q Stsc� rdr <br />OWNEn MAIL AIXNIE SS CITY ZIP PHONE <br />TENANT MAIL ADOPT SS CITY 71P PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY 7n• <br />PHONE <br />AQRou-) cewc,—i 4q(a <br />(o7E9W0c-I0J(? lkkj5c-)L 48170 <br />65`c•(3'17 <br />AQRoLfcoFF-T0 <br />OENEIML CONTRACTOR MAIL ADDnE SS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />tTp-( (7,5 (:?, 4 &C-r <br />s to o <br />MECHANICAL CONTRACTOR MAILADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />r <br />A7w d�4(na-�63tNr, <br />_ NnI SJL <br />PLUMBING CONTRACTOR AILADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />{',) a -To 0 <br />iRA{:7'PRICE OF WORK <br />191611 <br />HEATING SYSTEM: Cl GAS XLECTRIC Cl <br />DESCRIBE WORK AND SQUARE FOOTAGE WVOIVED <br />rotJ «<Fx al / <br />CONTACT rrnSON AND PHONE NO <br />aal awccjt 3�0 65f-13 i <br />1 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 />CONTRACT RS LAW 18.27 R/CW AND 2n200 AC. <br />`.-a7 <br />PROPOSED USE OF BUILDING <br />IF ( L''-ICJ Z I A �- <br />LEGAL OESCIXPTION OF PROPERTY IS14OWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK Or <br />- 00 Q - <br />PARCEL TAX I D. NUMBER <br />CONSTRUCTIONI^AN LENDER. ADDRESS. TELEPHONE NUMBER <br />NATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-AMNDLG UNITS <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS <br />' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK 8 DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />' <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />; <br />SINK (SERVICE — BAR. ETC.) <br />I <br />GAS PIPING <br />' <br />' <br />EXHAUSTFAN <br />I <br />I <br />' <br />I <br />I <br />' <br />r� <br />SUB TOTAL S <br />' <br />SUB TOTAL S <br />' <br />PERMIT $ <br />I <br />PERMIT S <br />I <br />TOTALFEE S <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETTBBACCK <br />TBAACK <br />BEAN SEET <br />SIDE SETBACK <br />MAW NUMflrn <br />N <br />FEE <br />PECFIPT NO <br />(N <br />W�7 <br />USEZONE <br />LOTAnFA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES flf NO <br />DUILDtNR <br />2 ( — <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />1 <br />2 <br />UNITS <br />) �. 1 <br />PLUMBING <br />OCCUPANCY <br />anam <br />NO OFSIONIS <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL' <br />_ <br />I <br />N " A <br />DYES NO <br />ADDITIONAL Pt AN CHECK <br />I <br />I — <br />FIRE SPRINKLER REO'D <br />REASON <br />' <br />N 0 <br />01 HER <br />FIRE ALARM RED <br />REASON <br />n/D <br />STAI E BLIIt DINn SI IRCIHARDE <br />TYPE OF CONS? <br />Pt ANS An �(FO BY <br />CITY OF EVERETT <br />runny. wDnKs <br />' <br />—''— <br />tI <br />LOCAL SALES <br />— <br />V <br />I L - I� - i <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />DATE <br />