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APPLICATILA FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET E EVERETT, WA 98201 1,259-8810 <br />1 1 DEMOLITION I I COMBINATION f I BUILDING I l MECHANICAL f I PLUMBING SIGN <br />PROJECT ADDRESS 15 I L_ -a S:tt S T WWI- S W &V/ ,Or <br />G06e4,r /AI�NJ,�/tL /}(PJCAi97�j1 I�1515/.DPfiiL'i66k l T ilZly,BOTk�fA 9Soli <br />TENANT III ADL81EB5 CITY 71P PHONE <br />W14 7Yusvaco�r�i'rc. z2oz7 �� kv�sE /)omit WA (1o6)y8)-�89 — <br />ARCHITECT OiDESIGNER MARADORESS CITY ZIP IgNE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />)�M Cot►SJTW-11a1N71�318-q-PhAVENt <br />CITY <br />S1dMTr� <br />98►ss <br />36?-Gsal <br />.•—xv�:••-- <br />J�MC0099em <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />TIP <br />PRONE <br />STATE LICENSEE <br />PLUMBING CONTRACTOR MAII. ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />54 -w Opo <br />HEATING SYSTEM: fl GAS ❑ELECTRIC C7 <br />DESCRIBE WORK AN $OUARE FOOTAGE INVOVED <br />CONTACT I EPSON AND PIKINE NO f <br />(A1RU� �M S Au n r1ITIT., D _ STM'A G+E <br />Al Sfl;;r'l /Al OOCI <br />F•EEiY uIL�)�� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME lU BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROPOSED USE OF BULOING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACH TWO COPIES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT BLOCK of <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />DERFORMANCE 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 />PARCEL TAX I NUMBER <br />X 7 Z <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />ATURE 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 FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C — A/HNDLG UNITS — H.P. <br />' <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />, <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />' <br />KITCHEN SINK 8 DISP <br />' <br />, <br />CLOTHES DRYERS <br />I <br />DISHWASHER <br />I <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />I <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />, <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />, <br />METAL FIREPLACE (WOOD BURNING) <br />P <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT(WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />' <br />, <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />, <br />OAS RANGE <br />' <br />' <br />GAS PIPING <br />EXHAUST FAN <br />' <br />-- <br />, <br />' <br />I <br />SUBTOTAL S <br />' <br />SUBTOTAL S <br />' <br />PERMIT $ <br />, <br />PERMIT S <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />. n. <br />FOR OFFICE USE ONLY:YS-'7/5,(y2(dtt -Ot'G QcU /cLl� GK� LL /• / <br />FRONT SETBACK I REAR SETBACK SIDE SITTBACK PL <br />AN CHEC NUMBER FEE RECEIPT NO <br />. it..i rN ..r'7i1 7w/i. / / / <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />rcca <br />AYES EI NO <br />DUKDING <br />))EIGHT LIMITATION <br />NO OF DWELLING <br />UNITSI <br />SIZE OF BLDGRI <br />AM <br />PLUMBING <br />MECHANICAL <br />OCCUPANCY NO IXSTOPoES <br />OCCUPANT LOAD BAS <br />ET7 MENT <br />'I <br />,I YES Il NO <br />ADDITIONAL PLAN CHECK <br />FIRE ALARM RED <br />REASON <br />OTHER <br />p 4 <br />FIRE SPRINKLER REOD <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC. WORKS <br />TYPE OF COAST <br />PLANS A D BY <br />CITY OF EVERETT <br />N9 <br />DATE 1 I - 90 - <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />