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APPLICATRA FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 •259•6810 OAM <br />Il DEMOLITION P-`COMBINATION I I BUILDING 1 1 MECHANICAL : I PI uMalun I I clru <br />PROJECT ADDRESS <br />OWNER MAIL ADDRESS CRY 71P r,10Nr <br />4 GE" DE fm ,4- cp& m iux, V 9r p! Sc C, Jm. l k "'LdLS o :5,-of3 ' 1 LS-S" <br />TENANT MAIL ADDRESS CITY RP r'IONf <br />ARCHITECT OR DESIGNER MAR ADDRESS <br />CITY 711, <br />r,IONF <br />lV2-S4,fiE. lJcrolx'«uck_ tldf <br />ytOu <br />GENERAL CONTRACTOR MAIL ADIMIL", <br />CITY TIr <br />PIIONL <br />STAT!. I ICENSE A <br />MTSS <br />CITY 71r <br />PIfONE <br />STATE LI-FNSEL <br />ac z l z t u 43-t� A * <br />S t . ca ndw r✓L <br />`6P, 1385 <br />t'tt�E of v+ C L3_ <br />PLU.M1BINGGC�ONTRACTOR MAII ADDRESS <br />CITY !IP <br />PHONE <br />5' ATE La& 15F.A P` 0�-ka <br />}A Lff.... <br />;rt, -% Q <br />A� N 0c1 ..1i.e A.1 W. .QyI lituC <br />f 2 L•f 1 <br />&9 <br />7= flf1?, <br />f- <br />CONTRACT CHILE OF WORK <br />HEATING SYSTEM: 4-rGAS F I ELECTRIC [I <br />OESCnIRE WORK AND SOUARE F TAGE INVOlVEO <br />.%C <br />CONTACT PERSON AND rH0NF NO <br />I HEREBY CERTIFY THAT 1 HAVE REED 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 THI_ WORK FOR WHICH <br />IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC S NN 18.27 RCW AN�200 WAC. <br />X rj (qua, <br />PRorosrous LD No <br />IEWLDESCRIPTI011 OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES; <br />LOT BLOCK _ or `Ai - Z Y <br />-000 - 0APPLICATION <br />PARCEL TEAIq Hu R��/ & ` / <br />CONSTRUCTION LOAN LENDER ADDRESS. TELEPHONE NUMBER <br />oWi <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL _ <br />NO. OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />_TYPE <br />A/C —A/HNDLG UNITS —H.P. <br />' <br />BATHTUB <br />I ' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />, <br />' <br />_ <br />SHOWER <br />' <br />UNIi HEATERS —B.T.U. M <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />I <br />VENTILATION FAN <br />�— <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />, <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />;a <br />GASFIREPLACE <br />, <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />' <br />GAS PIPING <br />' <br />EXHAUSTFAN <br />, <br />1 <br />, <br />SUB TOTAL E <br />) <br />SUBTOTAL E <br />' <br />PERMIT f <br />I <br />PERMIT E <br />I <br />TOTALFEE E <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />rnpR q"nACK / <br />/V'T_ <br />RE FTBACK 1/SIDE <br />SETBACK % <br />MAN C11E �%�� <br />r r <br />RFCFIPT NO <br />USE ZONE. <br />IOTA" aQ/ <br />VACANT snr <br />;]YES II W) <br />FEES <br />VALUATION <br />FEE <br />nuILnING <br />rluMnl+o <br />Q� �j� <br />_ <br />�f% , <br />`ate <br />, <br />, <br />HEIGHT LIMITATI / <br />NO OF DWELLING <br />uwrs <br />I! IN plIX}r� <br />�- J <br />;AKAcv <br />1,10 Sg GARAGE <br />OCCUPANCY NO M IILNALS <br />UP <br />IL..v i-Z <br />.fE <br />OCCUPANT lOAll pASEMENT <br />11 YFS �dfitl <br />MFCIIANICAl <br />-- <br />ATIDI IIONAI. M AN OIFCK <br />) <br />FIRE ALARM REOD <br />- _ <br />Rf ASON <br />OTHER <br />i <br />, <br />fIRF SIMIINKIFR REOD <br />Hf ASON <br />STATE nURDING S0nCHAnRE <br />-- <br />i D <br />TYPE OFCONST <br />PIANSAPPn.YF nY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBIIcWORKS <br />}— <br />TOTAL <br />_ <br />) <br />