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- APPLICATION FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION 77 <br /> 3200 CEDAR STREET • EVERETT, WA 98201 • 257-8810 tY <br /> f-` DEMOLITION n COMBINATION l J BUILDING 17 MECHANICAL F PLU ING.do !GN <br /> PROJECT ADDRESS140opkh <br /> OWNER •. MAIL ADDRESS Jf l CITYZIP PHONE <br /> Ul o I U �fi-' Q _034 <br /> 0 5 _34z , <br /> TENANT MAIL ADDRESS tITY ZIP PHO <br /> lov <br /> ARCHLFECTORDESIGNER MAIL ADDRESS CITY ZIP IONE <br /> Vj <br /> GENERAL CONTRACTOR MAIL ADDRESS 1 �� CITY ZIP P NE TE LICENSE a <br /> p GJ 5 3 b&CK C *b1 b&, <br /> MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PHONE STATE LICENSE s <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY LII' W)NE STATE LICENSE# <br /> CONTRACT PRICE OF WORK <br /> HEAT G Y TE Asir-, ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE FOOTAGE I LVED CONT PE N A P E NO. ;�OC.-M- _1904R <br /> I �HERI CE AT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDINGA TI A W THE SAME TO BE TRUE AND CORRECT.ALL <br /> OVI OF AND ORDINANCES GOVERNING THIS TYPE OF <br /> K IWEE MPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRIPTION OF PROPE}R�TY(SHOWN BELOW 011 ATTACH TWO COPIES) O E RANTI OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT I BLOCKt1( 6-StTOF 3`(�Ye `-Y E� ORI TO LATE OR CANCEL THE PROVISION OF ANY <br /> HER ST 0 OCAL LAW REGULATING CONSTRUCTION OR THE <br /> P FORMA F 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 /> PARCELTAX I D.NUMBER CONTRACT S A 18.27 RCW AND 296.200 WAC. <br /> W s-a-�+ vo$ v <br /> CONSTRUCTION LOAN LENDER,ADDRESS.TELEBHO UMBER X( i — <br /> SIGN URE <br /> 03-315 <br /> '31 DAT <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTU TE FFg-fj NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOWN&L A/C—AlHNDLG UNITS <br /> BATHTUB lk X Irff ? FORCED AIR SYSTEMS _ <br /> LAVATORY(WAS N) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DIS CLOTHES DRYERS <br /> DISHWASHER 1 RANGE HOOD <br /> LAUNDRY TRAY 7 'I WATER HEATER <br /> CLOTHES WASHER JIF v A !N WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAI i FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE <br /> BACKFLOW PRE NTERS '`� i GAS RANGE <br /> SINK(SERVICE,BAR. ETC.) \ GAS PIPING <br /> EXHAUST FAN <br /> J <br /> SUB TOTAL $ SUB TOTAL/'$ <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ TOTAL E $ <br /> FOR OF CE USE ONLY: <br /> FRONT SET CK _ ( REAR SET-B'A'CCK SIDE SETBACK- PLAN ECK NUMBER FC 00 l/— RECEIPT NO. <br /> USE Z I.OTAREA ,.� / VACANT SITE FEE VALUATION FEE <br /> l YES O BUILDING <br /> H HT L IMI ATIgN No OF DWELLING SIZE OF BLDG/T 1. <br /> I INI T S PLUMBING <br /> OCCUPANCY NQ OF STORIES OGGIIPAN7 LOAD BASEMENT MECHANICAL <br /> GROUP <br /> rl YES Fl NO <br /> ADDITIONAL PLAN CHECK <br /> FIRE SPRINKLER FIFO I) RFASON <br /> 1 <br /> t <br /> OTHER <br /> _ i <br /> FIRE ALARM REO'D RFASON <br /> i <br /> STATE BUILDING SURCHARGE <br /> TYPE OF CONST PI ANS APPP,,I'FD BY CITY OF EVERETT PUBLIC wnriR, i <br /> LOCAL SALES <br /> DATF TAX CODE IS 3105 TOTAL '' <br />