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APPLICATIC -I FOR CONSTRUCT 3N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET • EVERETT, WA 98201 •259.8810 <br /> ❑ DEMOLITION Ef COMBINATION ❑ 9UILDING El MECHANICAL 11 PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: ,L� QI uJ <br /> -i3• f J /J1�Yf�so�/ /suit`' � 4 '� ,pE �� r/���E . r 9FD� : j��•- -3 // <br /> OWNFFT� MAR ADORE Ss <br /> CITY tlr PHONE <br /> TENANT MAIL AOO tSS f.ITv lip PHONE <br /> ARCNTCCT On OES, (IGNLn ! MAIN ADDRESS CITY IIP PHONF <br /> � T,;T,rs , CNj;,' ddj SI A1C L IC w A AGnu J2 61C1 iE1F1 <Os_J�(i <br /> GENERAL CONTRACTOR MAIL ADDRFSS CITY lir mION SIAIC IICf NSE. <br /> MECHANICAL CONTRACTOR MAIL ADORFSS f.1 TY IIP PHONE STATE LICENSE <br /> PtOMBING CONTRACTOR MAR ADDRESS CITY ZIP PHONE STATE LICFNSFI <br /> CONTRACT PRICE OF WORN <br /> HEATING SYSTEM: UGAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORM AND SQUARE FOOTAGE INVOLVED CONTACT PFRSON AND PHONE NO <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING 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 /> LEGAL DESCRIPTION OF PACIPI ISHOWN BELOW011 ATTACH TWO COPIESI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> A ,p OTHER STATE OR LOCAL LAW REGULt'ING CONSTRUCTION OR THE <br /> O 6, - �J �/}T// cj Ca PERFORMANCE OF CONSTRUCTION.TI T I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO:'L'RTY TO PEI.)ORM THE WORK FOR WHICH <br /> APPLICATION,'IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAR 10 NUMBER CONTRCT S LAW 16.27 RCW AND 296.200 WAC. <br /> CONSTRUC TION LOAN LENDER.ADDRESS.TEI EPHONE NUMBER ,L � <br /> -� —_ <br /> V,Nyu, <br /> DATE <br /> CITY BUSINESS l ICENSC NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) <br /> A/C-AMNDLG UNITS �— <br /> BATHTUB FORCED AIH SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP —_T— <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 FISP CLOTHES DRYERS <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE <br /> BACKFLOW PREVENTERS _ GAS RANGE <br /> SINK(SERVICE-BAR.ETC.) GAS PIPING <br /> EXHAUST FAN <br /> SUFI TOTAL S SUBTOTAL S <br /> PERMIT S PERMIT $ <br /> TOTAL FEE S TOTAL FEE S <br /> FOR nFFICE USE ONLY: <br /> AONTSFTRACK RFAn SFTBACM_ SIDE SETBACK r1ANGILCA NLIMBrn FFF nFCFIPT NO <br /> •>i7 � <br /> ISE ZONE LOTAFEA VACANT SITE FEES VALUATION FEE <br /> _ �' / GZ-?D OYES ❑ NO nUIIDNG <br /> RIGHT LIMITATION <br /> / NO OF UWE)LING SHE OF BIQGRI <br /> /f A2 uNUc (V H'L at <br /> Sf. LIVI w1CI + rluunlNG �I—}— <br /> /Cl I S.f IC <br /> _L 7 OCA <br /> ICCUPANCY NO FB 510"1 OCCUPANT LOAD BASEMENT I <br /> RWP /J MFCIIANICAI / <br /> IRE SPRRIIN—KLER PLO'0 RF ASON ADDITIONAL PI AN GITCK 9A <br /> OluFn <br /> RE ALARM REO'O 11FA50N <br /> STATE BUILDING SunOunOF <br /> YPE OF CONS rIANS APPA VF By CITY OF EVERETT PUB1Ir.wnnK : <br /> +{ LOCAL SALES _— --- a--��-- <br /> '/� DATF 5 TAX CODE IS 3105 TOTAL Y 1<J ,,dQ <br />