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APPLICAT11.4 FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT R BUILDING DIVISION <br /> 3200 CEDAR STREET R EVERETT, WA 98201 R 259.8610 <br /> f l DEMOLITION I I COMBINATION 14-BUILDING 11 MECHANICAL 1 1 PLUMBING I I SIGN <br /> PROJECT ADDRESS 3/2 <br /> 7 „ /h /T�JI J <br /> oWNEn n MAK ADDRESS C�1 `J CITY 7m rHONE <br /> /))/}f ff50N CCJN� /sy/f- J9eAUrr irk//f C. � ./� SFU/z 3/4 <br /> -T RANT MAIL ADME.SS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br /> /))CL AL!Zj r- 2_ef.Avst /YI Cre. e9Yo/ 2- 3/G- F3G/ <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSER <br /> ACI fsKzo.r.c') W <br /> MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSER <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY 7IP PHONE STATE LICENSER <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: !:#GAS f-1 ELECTRIC n <br /> DESCRIBE WORK AND SOUARE FOOIALLE INVOLVED CONTACT PERSON AND PITONS NO <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 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOWO. TTACH TWO COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK or �e r L 1 A5 e 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 PROPERT f .O PERFORM THE WORK FOR WHICH <br /> APPLICATION AS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA) o CONTRACT SLAW 18.27 RCW AND 298.200 WAC. <br /> CONSTPUCRON LOAN LENDE. ADDRESS.TELEPHONE NUMBER X �, <br /> 5 TU DATE <br /> CITY BUSINESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE - <br /> WATER CLOSET(TOILET) ' A/C-A/HNDLG UNITS-H.P. ' <br /> ,r, BATHTUB ) FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I HEAT PUMP I <br /> / SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> / KITCHEN SINK 8 DISP i / CLOTHEQ DRYERS i <br /> / DISHWASHER ' VENTILATION FAN ' <br /> LAUNDRY TRAY RANGE HOOD i <br /> CLOTHES WASHER I WATER HEATER <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) <br /> FLOOR DRAIN ' FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS GAS FIREPLACE <br /> SINK(SERVICE—BAR,ETC.) I GAS RANGE ' <br /> ' OAS PIPING ' <br /> EXHAUSTFAN I <br /> I ' <br /> I ' <br /> I <br /> I <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ I PERMIT $ <br /> TOTALFEE $ ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK / REAR SET .K SITE SETBACK J PLAN CHECK NUMBER FEE RECEIPT NO. <br /> 7 2, <br /> USE IONS LOT AZ /]� VACANT SITE FEES VALUATION FEE <br /> //P U 1'1YES 11 NO BUILDING <br /> 15,al- W71 <br /> HEIGHT LIM ATION / NO of DWELLING SIZF.Or BL <br /> J <br /> UNITS 1�A74 lC LIJ/AIG ! PLUMBING <br /> SI CALAC,15 <br /> OCCUPANCY NO OF STIMIES OCCUPANT LOAD BA5EMENT MECHANICAL <br /> GROUP � � <br /> k'•3 U'1 2 4 nYES INSO <br /> FIRE ALARM REED REASON AD010010L PLAN CHECK <br /> OTHER <br /> FIRE SPRINKLER REO'D REASON <br /> STATE BUILDING SURCHARGE <br /> TYPE OF CONST PLANSArPTI VEDDY CITY OF EVERETT PUBLIC WORKS 2 <br /> �}- ✓1� LOCAL SALES <br /> JL-� pATE TAX CODE IS 3105 TOTAL 2 <br />