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APPLICATILA FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 • 259-8810 ur <br />❑ DEMOLITION II] I� nCO,�MBINATION fJ BUILDINGS I I MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRE�S: ` 20 &$ r[' IGC Q S Lam/ (3�Gf <br />1�l�_CcU��yr1 - - - �%------- —kfZ <br />MI1•I A ES CI- iY —(�� Ilip PHONE <br />TENANT MAR Ab11nrss------i�� ---- 155 3nO/J <br />CIIY rIK]NF <br />A 111TECT On OESIGN[n MATT ADDUESS --- — CITY -- 'p• --- rIIONF <br />ENERAL CONmACTm MAII MXIFIFSS 7 <br />PllOrl! STATE LICENSE. <br />MECIMNICAL CONTTIACTOFI MAq AODRF SS ('In <br />rIION( STATE LICENSE r <br />PLUMBING CONTRACTOR MAIL AINIDESS CITY HIV --- 1111NE <br />STATE LICENSE r <br />CONtRACT TRICE or VV07 — ---- <br />L HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />D SCRIBE WORM AND SGl1An FOOTAGE VIVOIVED � <br />IdeA✓ r.ONIN11 I'l TISON AND PIIONt NO eaxve.gna �nst�,// CAmpasf-bhs <br />I <br />PnOPOSED USE OF BUILDING <br />LEGAL DESCRYuON or FROPERTY ISNOWN BELOW On ATTACH TWO COPIES) <br />LOT BLOCK _ Or <br />CONSTnUCi ION LOAN IFNr)Fn. ADOFIESS. Tl LEIN1oNE NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET ITOILETL <br />SHOWER <br />KITCHEN SINK 6 DISP <br />LAUNDRY TRAY <br />CLOTHES WASF' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEII STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OP THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONI RACTOR LAW H! 27 RCW AND 296.200 WAC. <br />NAINnI DATE <br />CIIY 01151NFss i crNSE NO <br />MECI IANICAL <br />TYPE OF EQUIPMENT FEE <br />_ _NC—AAiNDLG UNITS <br />_ FOFICED AIR SYSTEMS <br />NEAT PUMP <br />_ UIJIT HEATERS <br />_ CLOTHES DRYEGS <br />_ RANGE HOOD <br />WATER IIEATER <br />DRINKING FOUNTAIN I - <br />FIIIT.PI ACE INSERT (WOOD BURNING) <br />FLOOR DRAIN 1 GAS IIRF:PIACE , <br />BACKFLOW PREVENTERS GAS MANGE `— <br />SINK (SERVICE — BAR. ETC.) �— GAS PIPING <br />_ _ <br />US _ EXI IAT FAN -- <br />- I <br />I - <br />SUB TOTAL S <br />PERMIT S i <br />TOTALFEE S I <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />B <br />FOR OFFICE USE ONLY: <br />!WONT SFiBACK RF.An SFiMf.K SIDE SETBACK rI ANI-I I[['K MIMIII II FT[ nFCI IPI NO <br />USE LONE IUI ADEA VACANT SITE FEES VALUATION FEE <br />_ ❑YFS ❑ NC nI/IITPIIG _ <br />HEIGHT LIMITATION NO Of DWELLING SIZE OF BLUOnI------- - I <br />UNITS — <br />OCCUrANI LUAO <br />BASEMENT <br />PIIIMBIN(i <br />OCCUPANCY <br />WMSIIVK[S <br />Group <br />Mf GIANIf.AI <br />OrEfl ❑ NO <br />------ <br />fIRESPRINKLERREO'0 <br />nFASON <br />AU)IIIUNAI PI AN L:III CK <br />of ARON <br />U 111p1_-_--- <br />FIREA MREO'D <br />SIAI I' OIIII III1111 SIIIII:IIAIIOF <br />TYPE OF roNST <br />MANS Anruuvfn ur <br />— <br />CITY OF EVERETT <br />Punur.wollKK <br />LOCAL SALES <br />------ -- . __—_ <br />DATE <br />TAX CODE IS 3106 <br />TnTAL <br />