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APPLICATIt,A FOR CONSTRUCT eON PERMIT <br /> CITY OF EVERETT -BUILDING DIVISION <br /> pj S I <br /> 100 3200 CEDAR STREET-EVERETT,WA 98201 .259-8810 <br /> DEMOLITION f 1 COMBINATION 1-1 BUILDING f-I MECHANICAL I PLUMBING SIGN <br /> DROJECT ADDRESS <br /> OWNER MAll.aODRE S' <br /> �± n �9y> CnALC12-L:H`/� Pyr�y TG- rill` "•' �'f'(-27 i7 <br /> ZNVAfl le 9— t..eLR°L_ Noft we -S�A.F��O ; _ <br /> TENANT MAIL ADDRESS CITY IIP PRONE <br /> ARCIBTF;T OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERA)UwTnvTon MAIL ADDRESS CITY ZIP PHONE STATE LICENSER <br /> 5irt-c {Gc 077 Cs <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE- <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE IT <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: )GAS Fl ELECTRIC fl__ <br /> DESCRIBE WORK AND SWARF FOOTA9�INVOLVED CONTACT PERSON AND PHONE <br /> N 6w S F• 1=r_ 1nt�yae� arsDa- <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 /> S F• !Z �"� C Lr 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 BELOW OR ATTACH TWO COPIES) NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT Z BLOCK OF 5*P I 101al--lAAUTHORITY 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 /> UWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX 1.0.NUMBER s IC Tied CONTRACTORS LAW 1 RCW AND 288.200 WAC. <br /> '3'735* — '000— R - ONoXr� cA .L�i J 3/ 9s <br /> CONSTRUCTION LOAN)ENDER,ADDRESS,TELEPHONE NUMBER • <br /> SIGNATURE <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> 3 WATER CLOSET(TOILET) I AIC-AMNDLG UNITS-H.P. ' <br /> 2 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 CLOTHES DRYERS i <br /> DISHWASHER I VENTILATION FAN ' <br /> LAUNDRY TRAY RANGE HOOD <br /> 1 CLOTHES WASHER WATER HEATER <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) I <br /> FLOOR DRAIN ' FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; ( OAS FIREPLACE ; <br /> SINK(SERVICE-BAR,ETC.) I GAS RANGE ' <br /> ' GAS PIPING ' <br /> IjjEXHAUST FAN 1 <br /> — I I <br /> I I _ <br /> I I <br /> I I <br /> SUBTOTAL S SUB TOTAL $ ' <br /> PERMIT $ I PERMIT $ I <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK RF.ARAp�(� ID .TBACK PLAN CIIEC PAB.R D FEE RECEIPT NO. <br /> usE ZONE LOTAREA// VACANT SITE FEES VALUATION FEE <br /> II YES IT NO BUII DING 00, <br /> HEIGHT LIMITAT101y, NO OF DWELLING SITTT���OF BLOB 1 <br /> UNITS � � } L N/AJ4 + PLUMBING <br /> OCCUP NO OF STp$S OCCUPANTLOAD BASEMENT o MECHANICAL <br /> �• <br /> .1 Z IV14 11YES KNO <br /> FIRE ALARM REDD REASON ADDITIONAL PLAN CHECK <br /> `TITER <br /> FIRE§PRPKLEn REDD REASON <br /> mSTATE BUILDING SURCHARGE <br /> TYPE CONST PUNsarrnoyEgBv CITYOFEVERETT PURLICWORKS <br /> `JIB- LOCAL SALES <br /> DarE S TAX CODE IS 3105 TOTAL <br />