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APPLICAT10h FOR CONSTRUCTII,.A PERMIT <br /> 01 Y OF EVERETT • BUILDING DIVISION <br /> 3200(;GUAR STREET A EVERETT, WA 98201 • 259-8810 <br /> ❑ DEMOLITION ] COMBINATION D- 311ILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �� 7 5 ✓�' C_ 3 C✓ <br /> OLA'N R MAIL ADDRESS CITY ZIP PHONE <br /> ��i ✓ �I/�1�'�0�,' /S er' v'_!"AJ SL /L//// c ✓rr,./C ?bZ/ L :J� <br /> TENANT f MMI ADDRESS CITY zip PI10NE <br /> ARCHITECT On DFSIGNIR MMI ADDRESS CITY ZIP PHONE <br /> O/LENE n,A�I CON InACTGB M,.,L ADOVESS CITY ZIP PIIONF. STATE IICENSE I <br /> �l/C/Ir�oti �ZUA, z77119,9 I)Icl MC•1 ryuAI. s J-rj? <br /> MECIANICALC:Y,TRACIon MWADDRESS CITY ZIP PIIONE STAtF LICENSE <br /> PLUMBNG CON(PMa011 MAIL ADDRESS CItY ZIP PHONE STATE LICENSE• <br /> CONTRACT PRICE Of VCRII <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE YiORK AND SQUARE FOJTAOE NVOLVED CONTACT PEnSON AND PHONE NO <br /> 1 HEREBY CERTIFY THAT I HAVE OAND EXAMINED T <br /> HIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT 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 ISIIOWLI 01I(A ATTAr,ryq COMESI NOT. TH9 GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT D BLOCK or—_ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> / OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ,,,7/,• J'j ��.0 L:r: PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> AP^LICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PARCEL TAA I D.NUMnEA CONTRACTORS W 16 21 RCW AND 266.200 WAAC. <br /> CONSTnuc T1OILOANLENFCr.ADDRESS,TEL EIYIONE NUMBER <br /> SKiNAT R DATE <br /> CITY BUSINESS IICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AIHNDLG UNITS <br /> ( BATHTUB FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) 1 HEAT PUMP �— <br /> SHOWER 1 UNIT HEATERS 1 <br /> I KITCHEN SINK 8 DISP CLOTHES DRYERS i <br /> I DISHWASHER 1 RANGE HOOD , <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER 1 WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> -:— <br /> _ FLOOR DRAIN GAS FIREPLACE 1 <br /> BACKFLOW PREVENTERS GAS RANGE ; <br /> r— <br /> _ SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> EXHAUST FAN <br /> , <br /> r <br /> I ; <br /> _ SUB TOTAL f SUB TOTAL $ 1 <br /> PERMIT S PERMIT S <br /> TOTAL FEE S TOTAL FEE f _ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACKREAR SFiOACK SIDE SETBACK PLAN CHECK NUMnT ftF' nff.FlPI NO <br /> Zo 00 <br /> USE ZONE Lor ARFA VACANT SITE FEES VALUATION FEE <br /> /(5, 716 Ii ❑ NO WIRING C —�— <br /> HEIGHT LIMITATION NO OF DWELLING SIZE Of BLOVI I — I-e1 , <br /> Z8 uans I6Sp-S.f. Llv u4 t PDIMnIND -niQ0 <br /> 'zyS G A1,A 1. <br /> OCCUPANCY NO DSI(KAIS OCCUPANT TOAD BASEMENT MFCIUPof.A1 �o ) D� <br /> K• �I <br /> -2— <br /> FIRE ❑YES HO --- 1 <br /> SPRINKLER REO'D nFASOH AUDIDONM.rI ANGIf CM 71'1 ) Qy <br /> auto 1 <br /> FIRE ALARM nED'D Rt ASDN -- <br /> SIAIE nURDNG SHnC,IAnGE — — IC 7l <br /> TYPE DCONSt P1 ANS Arrnovtn BY CITY OF EVERETT PUAI TCW PKI <br /> LOCAL SALES ---- --- -- f-- <br /> DATE (a ` TAX CODE IS 3105 TOTAL <br />