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APPLICATIC" I FOR CONSTRUCT' 1N PERMIT <br />rITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 93201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION] BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJE �'T ADDRESS: 112 (1c ) 6 <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />�111A Q l� (5 G:-"7)T (c�£532 l,1(L_t cTc� LL.��Y Sr-11Y� �jA ZSS� 3 � 7—;TA 7 <br />1 �ILANT MAIL ADDRESS CRY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONEE 7OAZ / �(Ae". <br />(Al/�ti°/3/) <br />Gk I <br />R44. 1l <br />GENEMLCONTMCTOR <br />MAR ADDRESS <br />CITY ZK' <br />PiIONE <br />STATE LICENSE <br />LOZ-4 <br />A/—L(dtl7uFl <br />�L <br />yy <br />J86'#lJ <br />MEC14ANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY TIP <br />PIIONE <br />STATE LICENSE I <br />PLUMBING CONTRACTOR MML ADDRESS CITY ZIP PHONE ST VE LICENSEI <br />s1 �7-1 lql" -- <br />CONTRACT PRICE OF WORK <br />S-s�' <br />� <br />HEATING SYSTEM: 60 GAS ❑ ELECTRIC ❑ __ <br />OESCRIBENOUNANOSWAREFOOTAGEINVOLVED � <br />/ — <br />CONTACT PERSON AND r110Nf. NO <br />I4,>,%, Ii70Q/lL- <br />S = A415 35-7-7?c-7 35CF-776 <br />L <br />III— ASzC' zz <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 />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 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br />X ( _] �.� •' 3� �G <br />PROPOSED USE Of BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN ITT LOW OR ATTACR;3 cowfsln'/ <br />�. P. �� - / y <br />LOT eLocK or - .� <br />PAKEL TAA 10 NumnEn <br />CONSTRUCYVJN LOAN LENDER, ADDRESS, TELEPHONE RI1MBEn <br />- <br />SIGNATURE d DAIE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURF. OR ITEM <br />FEE <br />NO. <br />_ <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —A/HNDLG UNITS <br />�— <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />�— <br />SHOWER <br />UNIT HEATERS <br />__ <br />KITCHEN SINK A DISP <br />i <br />I <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />_ <br />i <br />FIREPLACE INSERT TWOOD BURNING) <br />_ <br />FLOOR DRAIN <br />( <br />GAS FIREPLACE <br />' <br />_ <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />; <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />� <br />' <br />EXHAUST FAN <br />F <br />I <br />I <br />SUBTOTAL <br />f <br />' <br />SUBTOTAL f <br />PERMIT <br />f <br />I <br />PERMIT _ f <br />_ <br />TOTAL FEE <br />f <br />' <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: ifL7/. 3/ <br />FRONT SETBACK <br />REM SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBFn <br />FEF <br />RECEIPT NO <br />-? <br />z <br />s <br />��, 9&) <br />�i <br />USE ZONE <br />IOTA A <br />VACANr SRE <br />FEES <br />VALUATION <br />FEE <br />?(? <br />I?L <br />-� <br />I44 <br />S ❑ NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF 0"" <br />NUMBING <br />I <br />�J <br />�8 <br />UNITS <br />I % s,f, <br />O RCUPANCv <br />NO Of SIMIES <br />OCCUPANT LOAD BASEMENT <br />MECHANICAL <br />('-IQ <br />ADDITIONAL PUNCHfCK <br />1 ' <br />❑YES OA <br />FIRE PR hLER REO'0 <br />REASON <br />�G <br />_ <br />J ` IiyY IRA 6Y�- e�- <br />OLIEER <br />FIRE NAPV REDD <br />Rf ASON <br />PLANS APPROVE OBY CITY OF EVERETT <br />STATE BUILDING SIInCHAnu <br />runic. WORKS <br />r� <br />!VPE U I:L7NST <br />LOCAL SALES <br />cpo I �D <br />-— <br />-'— <br />�- <br />RATE 9(n TAX CODE IS J106 <br />TOTAL <br />(e I - <br />7 <br />