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APPLICATICod FOR CONSTRUCT rON PERMIT <br />CITY OF EVERETT I BUILDING DIVISION <br />3200 CEDAR STREET •EVERETT, WA 98201 •259-8810 <br />1 1 DEMOLITION I i COMUINATION /BUILDING I MECHANICAL PLUMBING I I SIGN <br />PROJECT ADDRESS <br />CITY ZIP r110NC <br />r1IV ne ........- <br />ARCMTECT OR DESIGNER MAIL ADDRESS CITY <br />PLUMBNGCCNTRACTOR MAIL ADDRESS GTY 1'IP PHONE STATE LICENSE <br />HEATING SYSTEM: -I <br />N GAS Fl E' ECTRIC I <br />DESCRIBE WORK AND SO' RE FOOTAGE INVOLVED <br />/1A/ ou 6r ( <br />CT PERSON Ayq PyoNg�10 <br />Xe <br />,•. r/ , <br />/p7Al.L.c-K l(� a.4, Z oG z it?GoSa <br />7-792 <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 <br />5/trinC-� <br />"' <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEOA SCNIPTION Or PIpPER (SHOWN BELOW A ACII Yro Cor esl <br />(O <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCIL _ or. CGC <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />T� ��-fi'�'� +�E y�iGu•� /-L T�� ZQ <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 />/CW <br />N <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.20D WAC. <br />MRCEL T 1 D NUMBER <br />'� 4a� �-l/ -�/ -Z. <br />CONSTRUCtION LOAN LENDER. ADDRESS. IFLEPNONE NUMBER <br />X ED 7 <br />SIGNATURE <br />DA1F. <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF EOUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />3 <br />WATER CLOSET (TOILET) <br />I <br />A/C—LVHNDLO UNITS—H.P. <br />1 <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS —B.T,U. M <br />KITCHEN SINK 6 DISP <br />I <br />CLOTHES DRYERS <br />' <br />DISHWASHER <br />I <br />VENTILATION FAN <br />I <br />LAUNDRY TRAY <br />I <br />RANGE HOOD <br />' <br />CLOTHES WASHER <br />, <br />WATER HEATER <br />URINAL <br />WOOD STOVE <br />- <br />I <br />, <br />GRINNING FOUNTAIN <br />1 <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />I <br />BACKFLOW PREVENTERS <br />_If <br />. <br />GAS FIREPLACE <br />OAS RANGE <br />) <br />, <br />SINK (SERVICE — BAR. ETC.) _ <br />' <br />GAS PIPING <br />- I <br />EXHAUST FAN <br />--+- <br />, <br />I <br />I <br />� <br />- <br />SUBTOTAL fSUBTOTAL <br />E <br />' <br />PERMIT $ <br />, <br />PERMIT S <br />, <br />TOTAL FEE $1 <br />' <br />TOTAL FEE f <br />I <br />I -UM UFFIGE U5E ONLY: LfC'7 i.ZtL <br />FRONT SETBACK / <br />REAP SFiPAC.M� / <br />'47 <br />BIDE SFigAr.Y / <br />MAN CIIFCN UMRFq <br />FEE <br />RECEIPT 40 <br />USE ZONE._ / <br />_ ii// <br />I Of ARF/.�� <br />((//Dp <br />VACANT SRr <br />Yf S I! hn <br />FEES <br />VALUATION <br />FEE <br />Suit ONq <br />IIEI011T LIMIUTI / <br />Z <br />INl Cr IIWELLINO <br />NJG <br />SIZF OF NI DORI <br />1 6 � (VMIA )4L7E'( <br />y <br />PLIIMOINC <br />WCUANICAL <br />OCCUPANCY lwT IN SPIRIT: <br />Group <br />Z <br />FIRE ALAnk4 RED'D <br />% <br />OCI:UPANI ICAO <br />Ac NT <br />ADMIRLNALMANCNF.CA <br />i <br />RFASO4 <br />OTHER <br />FIRF SPNNRI FR Pro D <br />RFArM <br />STATE DINIDINO 5URL11ARDE <br />_ <br />TYPE orrroFlsT <br />PIAwsArrnovrrµ>,a-r <br />JF1 <br />UAT $/% /yam <br />CITYC" VERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />PURUC,WORKS <br />TOTAL <br />---- <br />( <br />, <br />_ <br />