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r- <br />APPLICATIC4 FOR CONSTRUCw, .ON PERMIT <br />CITY OF EVERETT R BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 05201 •254-W 10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING n SIGN <br />PROJECT ADDRESS / <br />nWNFw MAIL ADDRESS CITY ZIP PHONE <br />,/Pm os/Kw y <br />r17o-<+�SA� try/,r- <br />A),11 fig e,C <br />98 <br />3/& - X34,- <br />TENANT <br />MAIL ADDRESS <br />CITY <br />71P <br />PHONE <br />ARCHITECT CA DESIGNER <br />MAILADORESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />;. Esyid•1=,="I6,cc <br />/r7/// c-r"CK <br />93 olI— <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />71P <br />PHONE <br />STATE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />CONTRACT PRICE OF WORN <br />HEATING SYSTEM: CiQAS ❑ELECTRIC ❑ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE N ). <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 />CONTFIAC0 LAW 11.27 R�%CWWAAND <br />,T296,200 WA{C. <br />(•( [/�" l- O 3�5.s <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OFkid4L�vI <br />PARCFL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER,/ADDRESS. TELEPHONE NUMBER A <br />P '11YY /�U L�OV 1�. /4v II <br />AUP '' DATE <br />7 <br />CITY BUSINESS LICENSE NO. 0 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS -- H.P. <br />' <br />% <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS - D.T.U. M <br />' <br />KITCHEN SINK & DISP <br />; <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />; <br />CLOTHES WASHER <br />I <br />/ <br />WATER HEATER <br />' <br />URINAL <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />' <br />f (REPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />G_4S FIREPLACE <br />SINK (SERVICE - BAR, ETC.) <br />9AS RANGE <br />' <br />' <br />"L <br />GAS PIPING <br />' <br />i <br />EXHAUST FAN <br />I <br />I <br />SUB TOTAL S <br />' <br />SUB TOTAL $ <br />PERMIT S <br />I <br />PERMIT $ <br />TOTALFEE S <br />' <br />TOTALFEE S <br />' <br />FOR OFFICE USE ONLY: % / 'u,, A 7 I (IJ- <br />FRONT SETBACK R <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZON9,7 <br />LOT AREA <br />VACANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />/� . /'1, l <br />1 'J'L <br />LT NO <br />HEIGHT UMITATICN <br />NO OF DWELLING <br />SIZE OF BLDGRI <br />UNITS <br />/?A/y SF <br />PLUMBING <br />(,I/ <br />I <br />s i s <br />UPPANCY NO OFSTORES <br />OCCUPANT LOAD BASEMENT <br />MECHANICAL <br />/ <br />GR <br />2- <br />� <br />A OYES In< <br />ADDITIONAL PLAN CHECK <br />IRE MREO'D <br />REASON <br />OTHER <br />I <br />FIRE SPRINKLER REO D <br />REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF CONST <br />PLANS APPROVED BY <br />I <br />CITY OF EVERETT <br />PUBLIC WORKS <br />I. - <br />TOTAL <br />� I <br />_If <br />5 <br />LOCAL SALES <br />TAX CODE IS 3105 <br />fu <br />DATE <br />