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APPLICATICC"! FOR CONSTRUCT' 1N PERMIT <br />(� 3 CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 A 259-8810 <br />❑ DEMOLITION O COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 7=13 52 (OL 5,e- <br />OWNED MAIL ADDRESS CITY ZIP PHONE <br />1�111A P_315 CQ vTI F (E-)iS32 Itit L.L C—j 2j2 ( r 1 St -Lc�� SYZSS� 357'73�7 <br />I[NANT MAILADOFIESS CITY ZIP PHONE <br />ARCIIItCCi d10E51G11CR <br />MAII ADDRESS <br />CITY )IP <br />PHONE <br />7 [1NS�2cll>i,�I% <br />10?32 111 to <br />�r�:?j- �k Si- -Bi, <br />GENERAL CONTRACTOR <br />ADDOE55 <br />CITY )IP <br />PHONE STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CIT/'Y lip <br />PIIONF STATE LICENSE A <br />n <br />/ <br />q� <br />C-t le A-0061rM &r/I/. <br />coNrrucr rnlcE of wonK <br />--,- C- ,. -f � I HEATING SYSTEM: M GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVE % <br />CONTACT PERSON AND PHONE NO <br />5 IS 3S-7 7 35L - 7-76 <br />I_ <br />1 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 W-L 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 I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />PnOPOSCO USE OF BUILDING <br />LEGAL OB56RIPRON CF PROPERTY (SHOWN BELOW On ATTACH TWO CnP1E51 <br />LOT BLOCK OF '� - <br />PARCEL TM 10 NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER-- <br />SIGNATUn'. DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF=IXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />72 <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS <br />�— <br />z <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />�— <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />( <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />; <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />—�— <br />URINAL <br />I <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />; <br />FLOOR DRAIN <br />( <br />GAS FIREPLACE <br />' <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />; <br />SINK (SERVICE —BAR, ETC.) <br />GAS PIPING <br />�— <br />EXHAUST FAN <br />I <br />I <br />I <br />SUU TOTAL <br />S <br />SUB TOTAL S <br />PERMIT <br />$ <br />I <br />PERMIT S <br />TOTAL FEE <br />S <br />' <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCIIECK NUMB. I <br />FEE r) <br />RECEIPT NO <br />USE ZONE? <br />— Ems- L <br />101 AREA <br />L� 3 ,� <br />VACANT SITE <br />Ems ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />'7C1 O <br />IIEIGIOT LIMITATION <br />Zp� ' <br />lvJ <br />NO OF DWELLING <br />urB15 I <br />512E OF BLDGFI I <br />1422. i f L1v IAJ(A + <br />�AS S,F. C.ptAaB_ <br />— <br />n1uuBINF <br />MCCHIANHCAI <br />(K <br />7 I <br />C(1C. H OC <br />OCCUPANCY <br />GnOIIR <br />EJ-I <br />NO Of 510FL11 <br />I <br />OCCUPANT LOAD <br />BASEMENT <br />❑YES ®'NO <br />ADDI I ZONAL PI AN GB CK <br />RRE PRINKCLER RED <br />REASON <br />OTHER <br />FIRE III REG D <br />REASON <br />, <br />STATE nuItniTT; s1111CHN1Dl15 <br />TYPE OF CONST <br />INANSAPPROVDpY <br />�f� <br />CITY OF EVERETT <br />LOCAL SALES <br />PuIC.. WORKS <br />rr <br />- <br />- <br />DATE 621I ( 'I <br />TAX CODE IS 3105 <br />TOTAL <br />I <br />E <br />FA <br />