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APPLICAT16H FOR CONSTRUC1 SON PERMIT <br /> CITY OF EVERETT • BUILDING DIVISION <br /> 3200 CEDAR STREET A EVERETT, WA 98201 A 259.8810 4rr <br /> I OEMOI.ITION I I COMBINATION X BUILDING I I MECHANICAL I I PLUMBING I SIGN <br /> OjZCT ADDRES YrPRR�nly PI W G=dAF_12 7_7 �WA <br /> OWNER MAII ADDRESS CITY ill` I`IIONf ��9Ex'L O'3 <br /> L� Di a&AAIS�A✓ f�oQ�u=�PP_rR is ����r�r_ zT WY3 -3Y,7-164F5- <br /> TENANT <br /> `/7-164F TENANT MAN ADDRESS CITY lip (HOW <br /> WHITCCT OR DESIGNEn MABAnDREss 'I'aµ/tdJ>a rlajq 98059 PHONF <br /> c.11M)f ck l:K�Go �oR� 69A/7 CoA Chi � SAE 6S//- 737 �r"n/cNbc o77 C. <br /> GENERAL CONTRACTO MAILADDRESS CITY :m PHONE STATELICENSE- <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITU llr PHONE STATE I ICENSEA <br /> PLUMBING CONTRACTOR MMI.ADDPESS CITY lIP PHONE STATE LICENSER <br /> CONTRACT PRICE Or WORK I <br /> L//1 HEATING SYSTEM: IXGAS I l ELECTRIC I l <br /> DESCRIBE WORK AVD SOUAPE FOO AGE INVOLVEb CONTACT rCRSON ANOpIIONE NO 0 -'2 Z I Y IM D A 10 <br /> _ raw A�cce <br /> ,4A4 <br /> 7 D A✓ 1oc G 1- 737 <br /> r no1�l AJ 3 -16,95- <br /> 1 <br /> s1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> L.� L APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSECI UBE OE BuypING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> S �� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCPrIDNOFPIROPERTYISHDWN BELOW OR ATTACH TVA CO^IFSI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT .Z. BLOCK._ _ _or oAC S 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 DY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAR EL TAK I D.MIM R CONTRACTORS LAW 18 27 W AND 298.200 WAC. <br /> A.�oa7A•a .-�rd93s=foo-i/£� — o00 <br /> CONSTRUCTION LOAN LENDER ADDRESS.TELEPHONE NUMBER X <br /> SIGNATURE <br /> CITY BUSINESS I(CENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) r r/ I ATC—AMNDLG UNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> �--- <br /> LAVATORY(WASH BASIN) / I HEAT PUMP ' <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP CLOTHES DRYERS ) <br /> DISHWASHER ' VENTILATION FAN ! <br /> LAUNDRY TRAY ) RANGE HOOD i <br /> CLOTHES WASHER I WATER HEATER ' <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) I <br /> FLOOR DRAIN ' FIREPLACE INSERT(WOOD BURNING) ' <br /> _ BACKFLOW PREVENTERS i GAS FIREPLACE ) <br /> SINK(SERVICE—BAR,ETC.) I GAS RANGE <br /> ' GAS PIPING i <br /> —� <br /> I EXHAUST FAN ' <br /> I ' <br /> I ; <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT S I PERMIT $ I <br /> TOTALFEE S ' T//O��TAL,F/EE S ' <br /> FOR OFFICE USE ONLY: ' 0.. Y <br /> mom SETBACK REAn SETBACK SIDE M <br /> SETBACK/ PLAN CI � / rCE 7 RECEIPT NO. <br /> 7�0 7-4::;pSA Io '/T/ 447 1 <br /> USE IOLjCj v/ LOT AREA VACANT SIT FEES VALUATION FEE <br /> K IIYE Il NO p <br /> BUILDING (.� S[o. 3(o 3 -n-30 <br /> HEI0I47 LIMITATION NO O<OWEWNG 512E Or BLDG/il ' <br /> unns Ibl4. S I REI, t PLUMBING -7-7Q� <br /> ge— <br /> OCCUPANCY NO Of STORIES OCCUPANT LOAD BASEMENT MECHANICAL O 0a <br /> OHOU <br /> O-1 Z I fTVEs O <br /> FIREMRED'0 REASON AWA RONAL PLAN CHECK <br /> OTHER <br /> TIRE SPR( LERPE.O'D REASON �1 <br /> STATE BUILDING SURCHARGE J V <br /> TYPE of consT Puns Mrnov ny =TALXOCODE <br /> ETT rusuc WORKS ' �O <br /> --��//-- ES <br /> .L- DATE 5l8/9 3105 TOTAL <br />