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APPLICATIC , FOR CONSTRUCT, IN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL [Z PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ��/'y - SI AD Q 's' 5 r <br />—MAIL ADDRESS - �G.lf'� tc�R ��i7—cc l•�3 <br />clry 71P PnpNE <br />rtnnm MAR ARNIf55 PITY lln <br />ARCHITECT OR DE r-HONER MAIL ADDRESS LIry nn <br />LItY 71P FRONT SIAIFIICFNSE• <br />MECHANICAL CON IHAL TOR MAIL ADIIFESS CITY ZIP rNDNE STATE IICFNSr,• <br />r1.:,4iAS El QE.�Lug 9I5I4 .,�4ygyEZ <br />PLUMB ,TOR \ ` ALL ADDRESS CITY ZIP PHONE STATE LCFNSFr <br />�1nrYYt,.VY,w �l <br />conrlAc cE or wont: <br />— <br />C <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE fRKnK AND SQUARE FOOT Mlva6eo / <br />t:atlAC. r Pr "SON ANn FRONT. NO <br />rt) <br />-P—no—POSED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />USE OF RUILDNG <br />`\'"� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION arn TnrvlsrawNBELOW onAnAcntwoCOPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />Lot _ BLO... or <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 TO FERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 206.200 WAC. <br />PARCEL TAK 1 D NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS TELErYONE NwnFn <br />x_ <br />slrnaune ouF <br />CITY BUSINESS LICENSE NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />_ FEE <br />WATER CLOSET (TOILET) <br />A/C — MiNDLG UNITS <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />; <br />I <br />_ <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />�— <br />— <br />/ <br />SFIOWER <br />I <br />UNIT HEATERS <br />I <br />/ <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />' <br />/ <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />/ <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN — <br />J <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />r <br />GAS FIREPLACE <br />T <br />BACKFLOW PREVENTLRS <br />; <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />I <br />I <br />, <br />SUB TOTAL S <br />SLID TOTAL S <br />_ PERMIT S <br />I <br />_ <br />PERMIT S <br />TOTAL FEE S <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />rRONTSFTBACK <br />nFAn SETBACK <br />SIDE SETBACK <br />PLAN CHECK NL,wrn <br />FEE <br />nFCFIrt NO <br />USE ZONE <br />IOF AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑YES ❑ NN <br />nut now, <br />I <br />REPORT LIMITATION <br />NO D DWELLING <br />SIZE OF FLOOR <br />i <br />UNITS <br />PLUMBING <br />OCCUPANCY <br />NO D SIfV4IS <br />OCCUPANT LOAD <br />BASEMENT <br />—i— <br />GROVr <br />MFCNANILAI <br />❑YES ❑ NO <br />-- <br />ADINIIDNAI PUN GnCK <br />— <br />) <br />FIRE SPRINKLER BIG D <br />nr ASDI <br />Gi HER <br />FIRE ALARM HEO'0 <br />REASON <br />F. TAT C BURRING SI IRCHAII <br />TYPE OF CONST <br />PI ANS APPnovFD BY <br />CITY OF EVERETT <br />runucwonrs <br />i <br />LOCAL SALES <br />TOTAL <br />—— — <br />—� <br />j <br />DATE <br />TAX CODE IS 3105 <br />