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APPLICATILA FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET R EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION ❑ COMBINATION X BUILDING ❑ MECHANICAL ❑ PLUMVING ❑ SIGN <br />PROJECT rADDRESS: yj2 9C11 ST <br />K� %•%t_XI+/✓__,yia�. E�� sr-f.,� �u..,d� F�✓,• �i�.-y•� <br />OWNER MAN ADDRESS CITY lip PIIONE <br />PHONE <br />ARCINTECT OR DESIGNER MAIL ADDRESS CITY <br />GENERAL CONLnACTOLI MAIL ADORE SS CITY III, PIIONF SfA'.1ICFHSE <br />MEGIUMGI I ...CIOn MAIL ADDRESS CITY TIP PHONE STATF LICENSE A <br />Pl11ANRING CONTRACTOR <br />MAIL ADORE SS <br />CITY jIP PHONE STATE LICENSER <br />CONTRA ICC VIORA <br />3 5 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE K AND SOII RE rOOIAGE INV <br />clA/a luc 360 �L�T�r <br />CD' C Fnsf 'Rf1✓yON1 NO / <br />�� I�11L V __r��_�-�— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME EO 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 />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAA�C. ,{/J <br />X ^I � 1�// ��V •�{i <br />PROPOSED US BUILDING <br />IEGALDESCmP IONOr PROPERTYISIfOVMRCLOWOn AnACGTWOC(NIESI <br />LOT DLocK orSY 3.3 95 <br />PARICEL TAK I D. IIUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />SIG N ATUR DATE <br />_ <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />A/C -MiNDLG UNITS <br />�— <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />-r— <br />SHOWER <br />_ <br />UNIT HEATERS <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS__ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />' <br />_ <br />DRINKING FOUN FAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR LRAIN <br />GAS NIREPLACE <br />BACKFLOW PREVENTERS <br />; <br />GAS RANGE <br />SINK (SERVICE - BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />SUBTOTAL S <br />SUBTOTAL f <br />_ <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRONT SETBA/CK/� <br />PFAFI SFTRAV <br />SIDE SETRA i <br />PLANCIIECK NUMnrn <br />FFF <br />nrCFIPT NO <br />USE ZONE % <br />(Of AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />nuitomr. <br />T <br />`— <br />❑Yrs ❑ NO <br />HEIGHT LIMITATION / / <br />2 <br />NO OF VVYELLING <br />UNITS <br />sin or SLDCRI <br />PIIIMRINO <br />f <br />OCCUPANCY <br />I NO TVSL004s <br />OCCUPANT LOAD nASFME Nf <br />MFI:HANICAI <br />GROUP <br />/ <br />AUOIOONAI PI AN CIIrCK <br />FIRE SPRINKLER REO'O <br />REASON <br />OTIIERf <br />FIRE ALARM REO'D <br />REASON <br />-- <br />$IA1L GUI( DING RIInCIfARGC <br />TYPE OF CONST <br />Pt ANS ArPnovrn nY <br />CITY OF EVERETT <br />PHnuc Wn"Ys <br />.JAB <br />LOCAL SALES <br />----- <br />�— <br />TOTAL <br />— <br />1 <br />p,/ <br />TAX CODE IS 3105 <br />_ <br />DATE o <br />