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APPLICATIL A FOR CONSTRUCT dN PERMIT <br /> C2o CITY OF EVERETT- BUILDING DIVISION <br /> 13,45 I c`,1T9 3200 CEDAR STREET - EVERETT, WA 98201 .259-8810 <br /> I DEMOLITION i t COMBINATION I I BUILDING MECHAVICAL PLUMBING I I SIGN <br /> PROJECT ADDRESS _ f <br /> 3iy Seri?/. S, W• �" ✓t'�GTT �/I 'pQsU -3 <br /> OWNrn MAIL ADHPE55II Trc Pfcw� 1'nOvr <br /> B <br /> /L �>w� eA.1,L CaAF.TGSE'"'� I/� � Z <br /> 4'/- -/ 37 - dFft <br /> fer NMM2TLQK1LACeRP .✓dfAAAlt, NSZ«_/X/IQ g�0$L] _ _ [014 - 7 %18_-_ lel 6151L. <br /> TENANT MAII ADDRESS CITY /IP FM1N� <br /> AncNrr.CT OR DESIGNER MAILADORESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAILADDnESS CITY ZIP PHONE STATE LICENSER <br /> MECHANICAL CONTRACTUH MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONI RACTOn MAIL ADDRESS CITY ZIP PHONE STATE LICENSEA <br /> CONTRACT PRICE OF WORK _ <br /> HEATING SYSTEM: GAS I ) ELECTRIC r1 <br /> DESLRIOE WORK AND BOUM�CTAGE OLVED CONTACT PER^ON AND PIIONE NO <br /> fL — <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOS 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 /> a-'r-f c G WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTIC.I Of I JPERTY(SHOWN BELOW OR ATTACH,O; COPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT L_BLOCK OP SY 1202- - 9 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTAX10 NUMBER 04.y„,J 04= •— CONTRACTORS LAW 18.27 RCV AND 296.200 WAC. <br /> 3 :3s - 000 — o I q - 000 <br /> CONSTRLICTIC:.LOAN LENDER,ADDRESS,TELEPHONE NUMBER X B•••T1 -9l <br /> SIGNATURE I DAI <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) I AIC—AIHNDLG UNITS—H.P. I <br /> 2 BATHTUB L FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> I <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> J KITCHEN SINK IL DISP i CLOTHES DRYERS i <br /> DISHWASHER I VENTILATION FAN I <br /> LAUNDRY TRAY I _ RANGE HOOD <br /> 1 CLOTHES WASHER WATER HEATER �— <br /> URINAL WOOD STOVE ' <br /> DRINKING FOUNTAIN I METAL FIREPLACE(WOOD BURNING) ) <br /> FLOOR DRAIN I FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) 1 OAS RANGE I <br /> ' GAS PIPING ' <br /> I EXHAUST FAN I <br /> 1 T <br /> I 1 <br /> I L <br /> 1 I <br /> SUB TOTAL S ' SUB TOTAL E ' <br /> PERMIT S I PERMIT S T <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACA REATISETBACyy BIDE ETBACK PLANCI IE'K NIIMnrnFEE RECEIPT NO <br /> USEZoN LOTAnEA VACANT SITE FEES VALUATION FEE <br /> / nYES rt NO BUILDING •711 (-171/ 90 <br /> HEIGHT LIMLTATIOL4/ NO OF DWELLING SIZE Or BLDGII <br /> UNITS 137S y'_ LAVIU { PLUMBING <br /> L 5 7 G”" <br /> OCCUPANCY NO O/STORIES OCCUPANT LOAD BASEMENT MECHANICAL <br /> FO <br /> 3 u-1 2 nvss nLAGo LOU Ott <br /> FIR ALARA)IEGD REASON ADDITIONAL PLAN CHECK <br /> y//G _ OTHER <br /> FIRES NKLERREOD REASON <br /> / STATE HUILDING SURCHARGE <br /> TYPE OT CONST PLANS APP11:0)DY CITY OF EVERETT PUBLIC WORKS 'r, �(] <br /> LOCAL SALES <br /> �-/J DATE cl 13 c/S TAX CODE IS 3105 TOTAL <br />