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APPLICATII.N FOR CONSTRUCT TON PERMIT <br />CITY OF ERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 ^ 259•8810 <br />I I DEMOLITION Ai COMBINATION Fl BUILDING Fl MECHANICAL fl PLUMBING SIGN <br />PROJECT ADDRESS <br />22 r <br />I <br />WNER MAIL AD7RF.S4 ( CITY zipPHONE <br />Y li(�4/r TE �✓ 4d'2G4� .4d6 752 /rdd <br />ARCHITECTORDESIGNEn <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ZIP <br />PHONE <br />STATE LICENSEE <br />TOR <br />cr <br />MAILADnnESS <br />CITY <br />7LC oAC <br />� l' <br />. it <br />MECHANICAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />pHm <br />STATE LICENSEE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />CONTRACT PRICE OF WORK <br />0 L) <br />HEATING SYSTEM: GAS Fl ELECTRIC f I <br />DESC IBEWORK ANDSWAREF00^AOEINVOLVCD / <br />0_1 <br />CONTACT P.gSONA HONEM <br />IwLl - <br />_ <br />D,� -/ v� I <br />/ ��'3J <br />I HERE13Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BET RUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER APECIFIED 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 />CONT fIA RPA�21RCWAND2B00 WAC. <br />�//CONSTRUCTION <br />♦ �/� OE; <br />PROPOSEDD USE OF BUIIdNG <br />LEauDEscnlrnoNOFrnorenlYTSHOWNeELOWORArucHTwocORI SI <br />LOT BLOCK a c, <br />ohr S'Q / S^'Z%al <br />PARCEL TAXI D. NUMBER <br />y&Z 0UkDA dUL <br />LOAN LENDER, ADDRESS. TELEPHONE NUMBFR <br />SIGNATURE DATE <br />�-vo, �lr✓ n 9 <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL _ <br />NO. OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />_TYPE <br />A/C — A/HNDLG UNITS — H.R <br />I <br />'y <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />'Z <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />1 <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />1 <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />/ <br />DISHWASHER <br />VENTILATION FAN <br />1 <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />' <br />1 <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />1 <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />1 <br />METAL FIREPLACE (WOOD BURNING) <br />—— <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT ('HOOD BURNING) <br />— <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />' <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />1 <br />' <br />GAS PIPING <br />1 <br />EXHAUSTFAN <br />�- <br />1 <br />I <br />I <br />' <br />1 <br />1 <br />T <br />1 <br />SUB TOTAL S <br />' <br />SUB TOTAL S <br />' <br />PERMIT f <br />I <br />PERMIT f <br />1 <br />TOTAL FEE S <br />' <br />TOTALFEE S <br />' <br />FOR OFFICE USE ONLY: rm. sit S 14 % 1 <br />FRONT SETRACR O� <br />REM SETBACK <br />SIDE SFTgACK <br />PI AN CIIECK NUMBF �,/ <br />FEF_2/ �� <br />RECEIPT NO <br />U iE ZONE -I <br />IOTAREA F <br />VACANT SITE <br />ES l NU <br />FEES <br />VALUATION <br />FEE <br />BUILnINO <br />ccc <br />r <br />O <br />14EIG14T LIMITATION <br />NO t DWELLING <br />IINIIS / <br />SI OF B�lpp�� 1 <br />Y 'q S, CIV.A/6 ./. <br />,S� $.F CAA <br />PLUMBING <br />—�� <br />W <br />pANCv Iq d SIGRf9 <br />.1 I <br />OCCUPANT IOAU BASEMENT / <br />AYES IyNf) <br />MECHANICAL <br />� O <br />�J <br />ADDITIONAL PLAN CHECK <br />FIREALAR REOD <br />D <br />FIFASON <br />OTHER <br />FIRE SPRI <br />NLEn REDO <br />REASON <br />STATE BUILDING SUnCIIAnITF <br />TYPE OF CONST <br />PUNS APPnOvED QY <br />V/r•'� <br />DATE Z/ (o <br />CITY OF EVERETT <br />LOCAL SALES <br />[TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />_ <br />k// <br />