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� <br />--,. <br />APPLICATIG�,,� FOR CONSTRUC7.ON PERIlAIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION Ll COMBINATION ❑ BUILDING ❑ MECHANICAL fl PLUMBING ❑ SIGN <br />PROJECT ADDRESS �, _ <br />OWNER <br />J�N �1�����7�Es <br />TENANT <br />�1G� %b1G,�%% �%� <br />ARCHITECT OR DESIGNEF <br />PW MBING <br />CONTFACI'PRICEOFWORK � <br />Df�/GG <br />PROPOSED USE OF BUILDING <br />LOT <br />�� �� <br />II:VOLVED <br />:RIPTION OF PROPERTY �SHOWN flELOW <br />BLOCK OF_ <br />iEE��i4ti>. <br />�� ti Pw�. � <br />CITY ZIP PHONE <br />C: rU��Yi�,4 yd�.�$ �'75• 35vv <br />CITY ZIP PNONE <br />�O �✓�C/1L/Liv',Il./n.A /.�.i11/'1P / i.�^ � �irn <br />CITY ' ZIP <br />�TY � <br />_y L <br />CI� 7 Pk <br />C�TY ZIP <br />PHRCELTAXL�.NUMBER <br />�� �Ngo�• 3 •.�y� • 000G. <br />CONSTRUCTIONL ANLENDEP.ADORESS.TELEPNONENUMBER <br />N/�: <br />awrneiNa <br />NO. TYPE OF FIXTURE OH ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />_ URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SEqVICE - BAR. ETC.I <br />FOR OFFICE USE ONLY: <br />FRONTSETBqCK RE�R SFTOACK <br />use zor+e <br />NEIGHT LIMIiATION <br />� nJo <br />FIRE SPRINKLEF REO'D <br />—�r-9� N� <br />TYPE OF CONST <br />V-n/ <br />SUB TOTAL 5 <br />PERA4IT S <br />TOTALFEE $ <br />SIDE SETBACK <br />LOTPREA <br />NO.OF�WEWNG ull <br />UNiTS <br />OCCUFANTLOAU <br />�9 <br />REASON <br />�=�; — <br />REASON <br />� <br />PLANSAPP OVEDBV <br />i� <br />a � <br />oaT= �n ' O — �7 � <br />PI10NE <br />,S�T.ATE ^LIf�,E-NSE k <br />AiE L.�—=JL— <br />55 , <br />STATE LICENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT P[RSON ANp PMONE NO. <br />�/wr/w_+ UO/ - -Qb�l <br />I HEREBY CERTIFY THAT I H E READ AND EXAMINED THIS <br />APPLIC.�TION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE I:OMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE GF CONSTRUCTION. THAT I AM AUTHORIZFD 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 L.4W 1827 RCW AND 296.200 WAC. <br />X �'�' _ <br />SIG ATU E DATE <br />CITY BUSINE55 LICENSIi NO. <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />A/C -AMNDLG UNITS - H.P. T— <br />FORCEDAIRSYSTEMS-B.T.U. M E.A. �: <br />UNIT HEATERS - I3.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE i <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />VACANT SITE FEES <br />❑YES ❑ NO pWLOMG <br />)F BLUG?I <br />3Q PLU'�BING <br />BASEMENT MECHANICAL <br />❑VES � <br />ADDITIONAL PLAN CHECK <br />OTNEP <br />STATE BUILDING SURCNARGE <br />CITY OF FVEP,ETT PU3LI� WORHS <br />LOCAL SAI.ES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S ; <br />PERMIT S � <br />TOTALFEE $ ' <br />FEE RECEIPT N <br />/��.�� ���� <br />VALUATION FEE <br />�Tn <br />�� 000 �/�J / i <br />