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APPLICAT16d FOR CONSTRUCT mON PERMIT <br /> CITY OF EVERETT A BUILDING DIVISION <br /> ,?sub() - 3200 CEDAR STREET• EVERETT, WA 98201 •259.8810 <br /> I -. <br /> F1 DEMOLITION COMBINATION f BUILDING I1 MECHANICAL I 1 PLUMBING f I SIGN <br /> PRJJECTADDRESS A,L , r k--�- 1,21, <br /> OWNER MAIL ADDRESS CITY ZIP PHONE l <br /> I n ��nm s l t,c Ik91 b 130+I,eU �r�re�� N,u� I�LW,cc11N,�L1(� `��i�►�Caa�Gl�i t,�bl <br /> TENANT MAII.AO0NF55 r.I1Y <br /> ARCHRECT OR DESIGNER MAIL AnDRMs CITY 71P PHONE <br /> 7be SlS,L��y I 6ikecks 4n k) n Icier . S ��aoa ,LSLhA\LSA 9 3lv ( 4�cSy 7' 3p <br /> O LLCOIITRAC1IW MAILADBIESS CN IIP PHONL STATE UCENSEI <br /> IS��co t�Y1es LDL\_ SAM(-.. 1'1'IET LoCk a43 K4- <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CATV 71P PHONE STATE IICENSE I <br /> \Alal�z Plumb�E _� Ip94h Sy S -J r 11 VA c; ang <2e) A '3 Oji - <br /> NUMBING CONTRAC•Tdl MAIL ADNIESS CITY 71PPHONE STAIF.IICENSEI <br /> _ II Pt��tTNa1�4�s1� <br /> Ldir T RICE OF WORK <br /> '3 HEATING SYSTEM: ><GAS Ll ELECTRIC fl <br /> DESCRIBE WOR NO SOUME FOOTAGE INVOLVEDCONTACT PFnSOII AND P ONF NO <br /> u c . nice rnr-1 Gr TVI;I ;e��ner <br /> Lnre `ae-V 1 !n a- L L Ad F I ?,1 icir 3a <br /> } 7aQ* I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �PRGPweO usE of euILaNG PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPERTY ISHOWN BELOW OORAATTACH TWO CC'IESI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK 0;7?hAUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> T� Ore <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> -• <br /> r1aA cA mPf( L' k OCP P . 2pCnrc1P d PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> N(o1Urn e r�C PIC�i � %C Pe T�CAPPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAXI D NUMBER d CONTRACTORS LAW 18.277 RCCWWA/ND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,ACORES&TEL EPIIONE NUMBER <br /> s ,N!1IFT DATE <br /> CITY BUSINESS I(CENSE NO <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. _TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) I Air–A/HNDLGUNITS–H.P. �— <br /> �_ <br /> BATHTUB ' FORCED AIR SYSTEMS–B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I HEAT PUMP <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ) CLOTHES DRYERS ; <br /> DISHWASHER 1 VENTILATION FAN I <br /> LAUNDRY TRAY I _� RANGE HOOD -yyJjpnc1 ) <br /> CLOTHES WASHER �— WATER HEATER I <br /> _ URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN I METAL FIREPLACE(WOOD BURNING) <br /> — <br /> FLOOR DRAIN I FIREPLACE INSERT(WOOD BURNING) �— <br /> BACKFLOW PREVENTERS I GAS FIREPLACE ; <br /> SINK(SERVICE–BAR.ETC.) I OAS RANGE I <br /> ' GAS PIPING ' <br /> _ I EXHAUST FAN , <br /> I I <br /> 1 _ I <br /> _ I I <br /> SUB TOTAL S ' SUB TOTAL $ ' <br /> PERMIT $ I PERMIT $ <br /> TOTAL FEE S ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> rRONT SETBACK PEAR SF11BACK SIDE SET ACK PI AN CIIECK NUMBER rEF nECCIPT NO <br /> J� o S S 2-010 6— 30 t/7W <br /> USE 7 NE I01AFIFA VACANT SHE FEES VALUATION FEE <br /> •3 I IYES I; Io) BNmBIG J <br /> UEIONT LIMITATION NO OF DWFHING SIZE OF 01K,'}/1JJ <br /> UNITS vQSf,GP111A111B!�, <br /> OCCUPANCY NO D SIORIS OCCUPANT IOAD BASEMENT 70 <br /> Dnal MFCIIMnC+I U <br /> �• 2 _arra AI - <br /> FIREALAR71MMREOR nFASON A1101IONAl PI AN CHECK <br /> DINER <br /> TIRE SPRINKIERREOD REASON -- <br /> STATE SHIT MNG SUMIMnOE <br /> IYPFOFCONST PlnrlsArrnOvennr CITY OF EVERETT PIXXH;WIXIKS <br /> f� LOCAL SALES <br /> /.{ nArE L3 90 TAX CODE IS 3105 TOTAL <br />