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APPLICATIO. FOR CONSTRUCT[ N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 A 259-8810 <br />DEMOLITION ❑ COMBINATION 'S BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />J4,r3t I dc/L r;z.1/R B!s-I. P! SF Elc/ceb NE< fro 3v7.oaRj ___ <br />ovivi MAIL ACIDDESS City ZIP PHONE <br />3n T,"C <br />TENANT MAIL AENNIESS CITY ZIP PHONE <br />A 6' E! <br />ASCHITECT DR DESIGNCn <br />MAIL ADORESS <br />A/1 Y7 ZY EEIA"e w <br />71P P14ONF <br />.ST) I ./ev F's <br />('c1/vs/. <br />.SA.e. SF_nr A✓nsN. <br />'Ps'/5, sr 29i-jazB 4DI'GR('Jl9Stio <br />GFNERAL CONIIIACVIri <br />MAIL ADDRESS <br />COY <br />71P P.IONF SIAIE LICENSER /-/6--F;7 <br />MFCIIANICAL CONTIIACTOR MAIL ADOnESS CITY 71P PIIONT SWr UCr NSE F <br />PLUMBING CONTDACTOn MAIL ADDRESS CItY TIP PHONE STATE LICE NSE• <br />CONTRAGf TRICE Of WORN <br />HEATING SYSTEM: ®GAS ❑ELECTRIC ❑ _ <br />DESCRIBE NANO SQUARE FOLIAGE INVOLVER �1 <br />CONTACT Prn(SON AND mw NO <br />i i pi off E .'!' /inn/ <br />u <br />n <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />V rJ 'FLr^ <br />APPLICATION AND KNOW THE SAME TO BE T RUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND OPOINANCES GOVERNING THIS TYPE OF <br />P SED USE Or BUILDING <br />/y _ <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEaALDESCRRI IONO+PROPERTYI511 RELOWORATIACH IWO COPIES) <br />' <br />LOT�RtocKOIY7 O.<'o or 1/All6 ViELrJ r✓ <br />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 10 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />— <br />CONTRACTORS LAW 10 27 RCW AND 296.200 WAC. <br />PARCEL TAK I D. NUMBER <br />X G�VL '�iYC-Jr1f� 7--,3 C>-�AJ <br />CONSTRUCTION LOAN LENOFn, ADDRESS. TtLEr ONENUMAER <br />SIGNAI URE DALE <br />CITY DUiR1ESS LICENSE 110 <br />MCCHANICAL <br />_PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT _ <br />FEE <br />WATER CLOSET (TOILET) — <br />--� <br />A/C—AtHNDLG UNITS <br />BATHTUB <br />; <br />FORCE D AIR SYSTE MS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />' <br />SHOWER <br />' <br />UNIT HEATERS <br />KITCHEN SINK 6 DISP <br />i <br />DRYERS <br />DISHWASHER <br />_CLOTHES <br />RANGE HOOD <br />LAUNDRY TRAY <br />) <br />WATER HEATER <br />i <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />) <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />_ <br />I <br />T <br />SUBTOTAL S <br />SUBTOTAL S <br />i <br />PERMIT S <br />T- <br />PERMIT S <br />TOTAL FEE S <br />' <br />TOTAL FEE S <br />rr II, I mr nul v. <br />flT <br />nrcrIPT NO <br />f nONT Sf fRACN <br />READ SF TRACK <br />SI GE SETBACK <br />Pt AN (TIIECK NOMRTn <br />VACANT <br />FEES <br />VALUATION <br />FEE <br />usE 1oNE <br />Lot AnrA <br />snr <br />/ <br />o YES O NO <br />mnInING <br />I <br />HEIGIII LIMItATION <br />_ <br />NO Of BWrL11N0 <br />SIZE a BLD3/11 <br />I INI I S <br />PL NMRING <br />' <br />i <br />MFGIANI(AI <br />----- <br />OCCUPANCY <br />NO FK 110011 <br />OCCUPANT LOAO <br />BA5FMFN1 <br />Gnour <br />I <br />❑v[S ❑ NO <br />--._ <br />APpIIONM PI AN CBf CK <br />_ <br />FIRE SPRINKLER REO'0 <br />nFA50N <br />_ <br />Gu1En <br />SIAI E RAIL DINO S11I1r."AnGE <br />i <br />i <br />FIRE ALMM ❑W D <br />Sir ASON <br />runnc WO"" <br />— <br />TYPE or roNsl <br />TANS Arrnovrn RrTTAX <br />TY OF EVERETT <br />LOCAL SALES <br />— ' <br />�� <br />-- <br />--- <br />CODE IS 8105 <br />TOTAL' <br />DATE <br />