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APPLICATI%I FOR CONSTRIll IiON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •259-8810 <br />DEMOLITION ❑ COMBINATION ❑ BUILDING I-1 MECHANICAL n PLUMBING SIGN <br />PROJECT ADDRESS 3&T 5 `. C-VezETT- A*u - W y O2% <br />OWNER MAILADDRESS CITY ZIP PIIONE <br />IPOV Pt+ILL.IP5 3oS 56. Cl All WY alb 6+6�r ^1820,r 77/-yffy <br />TENANT MAILADDRESS GIN ZIP PIfONE <br />�NTIfoNYS O&VpL. W6�IR ?o, S� L�vBtP1T Mtu-�Y • g FIl z<lB 77/- y8gl% <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />DDRE <br />IIP PHONE STATE LICENSE N <br />GENER_ AI CO ;TRACT/11WIV IN/MAIL ArYSSO_V_i� �7 i� I ���NWGCV 9Y6 *776-8?35 &9?RYIJC07-7cM <br />MECHANICAL CONTRACTOR MAILADDRESS CITY ZIP PIIONF STATE LICENSE. <br />MAILADDRESS CITY ZIP PHONE STATE LICENSE. <br />CONT HACT PRICE OF WOR <br />_ 15.90�° <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />�0D 3. LL D L <br />CONT T PERSON AND PI10N�t+O <br />N M. C Atl-YL 67 N&N Iw. <br />N(r 60,01p A,&ymiwAop W <br />7 6- 83S <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 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 />S LAW18.27 R W AND 296.200 WAC. <br />CONTR T ,411k <br />X 7� • W1A t Qf/ yt9T <br />SIGNATUR l G 2�f / 3 ATE <br />PROPOSED USE OF BUILDING <br />CO/Amll <br />LEGAL DESCRIPTION(:F PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ALDRESS, TELEPHONE NUMBER <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS — H.P. <br />T <br />1 <br />BATHTUB <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />1 <br />HEAT PUMP <br />1 <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />KITCHEN SINK & DISP <br />i <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />VENTILATION FAN <br />,— <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLCOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />' <br />GAS PIPING <br />i <br />EXHAUST FAN <br />I <br />I <br />� <br />I <br />SUB TOTAL 5 <br />SUB TOTAL $ <br />PERMIT S <br />1 <br />PERMIT S <br />1 <br />TOTAL FEE $ <br />1 <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHEC NUMB��,✓ ER`_ <br />EE[ <br />7/A <br />RECEIPT NO. <br />G� <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />C -1 <br />II YES O NO <br />BUILDING <br />1 <br />HEI5YTLIMITATION <br />NO. OFDWELUNG <br />SIZE OF BLDGILL <br />u_(� <br />UNITS <br />PLUMBING <br />' <br />OOCUPANCY 110. OF STORIES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />GROUP <br />1 <br />LTYES ❑ NO <br />ADDITIONAL PLAN CHECK <br />I <br />FIRE ALARM REO'D <br />REASON <br />OTHER <br />i <br />FIRE SPRINKLER RED <br />REASON <br />STATE BUILDING SURCHARGE <br />1 (� <br />TYPE OF CONS('. <br />PLANS APP OV.D BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />j;117 f9hr <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />�_ <br />DATE om <br />