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APPLICATIO., FOR CONSTRUCT6 _)N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 2�c j <br />PL• C.GA <br />OWNFn MAIL AODRESS CITY ZIP PHONE <br />IA./EQstA%) IL%'V— l..,u nl—. 1?..7 Ik. -?q-7-73v7 <br />TENANT <br />uAII ADDRESS <br />CITY <br />NIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />lip PHONE <br />GENERAL CONTRACTOR <br />MAIL ADORE SS <br />CITY <br />llr PONE STATE LCENSE I 01PRED IIOInO <br />CONTRACT PFKCE OF WORN <br />HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br />OE SCRIBE WORK AND SOUARE FOOTAGE NNVOL <br />CONVICT PERSON AND PHONE NO <br />T (uN IP/L S 35 7 73G 1 �jG - 77C 7 <br />Coo A-1.c « /' L <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 WI-H 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. THAI" I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORT( FOR WHICH <br />ICATIO ADE AND I COMPLY WITH THE STATE <br />C N C LAW 27 ROW AND 296.200 WAC <br />X <br />PTTaroDFGL19f FRNALdNG <br />�7 <br />LEGAL DESCRIPTION OF PnOPEnTY(SIOWN BELOW OR ATTACNTWOCONESI <br />LOT BLOCK OF <br />PrncE, To in NUMeEn <br />COYSinlYRd110AN LENOEn. AOINiESS, TEIEPHNONF. NUMBEn <br />SO U E 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 />--�— <br />WATER G.OSET (TOILET) <br />' <br />AIC — AMNDLO UNITE <br />' <br />BATHTUB <br />' <br />I <br />FORCED AIR SYSTEMS <br />i <br />2. <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />I <br />z <br />SHOWER <br />' <br />UNITHEATERS <br />i— <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />( <br />DISHWASHER <br />I <br />RANGE HOOD <br />' <br />' I'JNDHY TRAY <br />WATER HEATER <br />( <br />. OTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />; <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />; <br />GASRANGE <br />_ <br />SINK ISERVICE — BAR, ETC.) <br />�— <br />GAS PIPING <br />_ <br />EXHAUST FAN <br />SUB TOTAL S <br />N <br />SUB TOTAL S <br />—�—_ <br />PERMIT S <br />N <br />PERMIT i <br />TOTAL FEE S <br />) <br />TOTAL FEE S <br />• ; I B]�IZ.��e7aAA <br />TAME SETBACK <br />Z� <br />PEAR SFTBACR <br />20 <br />SIDE SFTBACF <br />Sr <br />PLAN CHECK NUMBFR <br />rFF ✓) <br />(/ <br />of CFIPT NO <br />USE 2 <br />-Z <br />IOTAnEA <br />-3 <br />VACANT SITE <br />ES ONO <br />FEE <br />VALUATION <br />_FED_ <br />DHAEKNG <br />O <br />/- <br />F 11-JJ <br />HlFanr uMlrNlr <br />rz' <br />No a DWELLING <br />UNITS <br />slid DF el / <br />14Z V Dry. 11ARA -} <br />f. <br />PtuMnwa <br />(� <br />Q�UPANCY <br />O 1 <br />NO O STMrF <br />OCCUPANT LOAG <br />BASEMENT <br />/ <br />OYES <br />MFCHANICAI <br />O <br />LY.Io. <br />I <br />AMBIKW,H PI AN CHr CK <br />FIRE SPRINKLER REGO <br />RF ASON --- <br />OTHER <br />1 <br />FIRE ALARM RED <br />REASON <br />SEAT ESUIT DING S111N:fIAT1r{F <br />�— <br />TYPE orr.ONST <br />-Aj <br />PIANSAPPROV€per <br />J 1-11 <br />DATE 6 i c. <br />CRY OFEVERETI <br />LOCAL SALES <br />I TAX CODE IS 3105 <br />PHHC Rwrii <br />TOTAL <br />01 <br />