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APPLICATIL_J FOR CONSTRUCT _aN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />❑ DEMOLITION COMBINATION ❑ BUILDING ❑ MECHANIC/AL U PLUMBING ❑ SIGN <br />PROJECT ADDRESS: aQr 1 � Xe <br />I �I! F�PInr �CL'NPDonEiS TY PHONE <br />/a-Y7Y `k' The _ S{_- Ol.;LLJ -2y2- <br />TENANT <br />MAIL APORFSS <br />CITY <br />lip <br />PHONE <br />ARCHITECT OR DESIGNED <br />Mtn MORE S <br />CITY <br />III, <br />PHONE <br />O NEON CONTRACTOR <br />Pok <br />MAIL ADDnFSS <br />/ CITY <br />ZIf <br />PUUNF <br />STATE I ICFNSE I <br />(rJI'n , <br />X,.,-F /)LVfy <br />H�� Ave sc <br />MECHANICAL CONVIACTOn <br />MAIL AOOFFSS <br />CITY <br />ZIP <br />PHONE <br />SlATF I ICFNSE I <br />PHOLISINGCONIDACIOD <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE I <br />CONTRACT TRICE OF WONT( <br />%U 0 oQ <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />OFSCRIEE WOfIK IWU SOU TIE 1,0�ZOLVED <br />CONTNT rrnSONAND PAON,L�n0(�C `?f 7 �lY <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO OE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORT( 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 />C ACTOR AW 1 7 RCW AND 296.200 WAC. <br />X � ��0/%E� <br />PROPOSED USE or pIRLTKNQ <br />�' ^� ` <br />LEGAL 1� PROM OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT _. .� _ STOCK or <br />sr r-yy <br />PARCEL TAR ID NUMBER (J --- <br />jr�Ylu- 0� 4OOL OOA' UlI UC70L <br />CONSTRUCTIONLOAN LENDEj/X AIXBIESS.TFLEPHONE. .mn <br />�YJ'��T,,_ IY�nK <br />SNiNA TAPE DATE <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 />WATER CLOSET (TOILET) <br />T <br />A/C—A(HNDLG UNITS <br />_ <br />41, <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />; <br />�-c— <br />LAVATORY (WASH BASIN) <br />1 <br />HhnT PUMP <br />SHOWER <br />' <br />UNIT HEATERS <br />' <br />KITCHEN SINK A DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />WOOD STOVE <br />_ <br />_ <br />_ <br />CLOTHES WASHFH <br />1 <br />_, <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />1 <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />.Z <br />GAS FIREPLACE <br />_ <br />BA(.;KFLOW PREVENTERS <br />GAS RANGE <br />; <br />SINK_(SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />SUB TOTAL S <br />n <br />PERMIT S <br />---�--J—' <br />/ / <br />PERMIT 1 <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCIIECKNWIBrn <br />FFF <br />RECEIPT NO <br />JU <br />CI / <br />5 <br />�i0,�)� <br />C% <br />USEZONF <br />TOT AREA `` <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE _ <br />'�.Z <br />CasTJ' <br />P"S ❑NO <br />BIRI DING <br />IMPORT UNNIATIQN <br />.-T y.� <br />NO OF DWELLING <br />IINIIS <br />SIZE OF 8lD6nl <br />I369 i. F. �I V W Q i- <br />/ <br />PLIIMDIN n <br />OCCUPANCY <br />arLo-lZw <br />NO 01510FL5 <br />OCCUPANT LOAD <br />BASEMENT <br />Mf CITANRAI <br />�Z <br />I <br />ADDITIONAL PIAN GRCM <br />�n ' <br />FIRE SPRINKLER REO'0 <br />REASON <br />FIRE AWM REO'D <br />REASON <br />STATE RWLDING SnDCIOnnE <br />T <br />i <br />TYPEOF C(INS! <br />PI ANS MPROVFDpY <br />CITY OF EVERETT <br />PIIpIlC Q1RKS <br />�y <br />LOCAL SALES't— <br />TOTAL <br />1 <br />K /.( <br />DATE <br />TAX CODE IS 3105 <br />7ff <br />