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APPLICATILA FOR CONSTRUC7.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 1,259.8810 <br />rl DEMOLITION Fl COMBINATION BUILDING fl MECHANICAL rl PLUMBING F1 SIGN <br />PROJECT ADDRES Q <br />26 `f z— rLl <br />DWHER MAIL ADDRESS CITY ZIP PHONE <br />)\ Sri <br />rcr, ` m nl <br />}� . <br />i�^�C I&o 115 �i?f� �i,1l <br />J, / t2, qg�11 gce-xl�-1,- <br />TENANT <br />CVe <br />MAIL ADDRESS <br />CITY <br />21P PHONE <br />`f'�;J: <br />r e rfi <br />i 0 �zc <br />i <br />ARCHITECT OR DESIGNER MAIIADRESS <br />GIN <br />21P PHONE <br />(GI\1pfChnSi✓Q 1�1�hfUirlrF fc�P Tr�n <br />�U}i IJ <br />t�jhER° <br />SLC�% 11221121%� <br />GENER LCONTRACI OR MAIL ADDRESS <br />CITY <br />CC 21P PHONE <br />STATE LICENSE• <br />I •mltlQr���{r�11c'1 Co <br />IMF �,raAr <br />; <br />lr+r�wt�r5lrkt9�LZC 5Y <br />bZi� Qn�ircc f�ioLs <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />q�� 7 <br />CITY <br />ZIP PHONE <br />STATE LICENSE F <br />/// _J <br />PU'MBIK3 CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />STATE LICENSE <br />OHTRAGt PRICE OF WORK <br />`." <br />HEATING SYSTEM: I I GAS FI ELECTRIC Ll <br />DE SCRIB WORK AND SQUARE FOOTAGE INVq,VED <br />CONTACT PERSON AND PHONL NO <br />!cn� <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 1 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 1B.2w7 RCW AND 296.200 WAC. <br />� &IL. � j`�il/���iY, q')f.�l�. <br />PROPOSEDUSE OF BUILDING <br />�.� - �� <br />LEGAL DE TION OFPR PE RTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT I BLOCK 22 ,-C - r IC I <br />fj j5• <br />PARCEL TAXI D. NUMBER <br />CONSTRUCTION I DAN TENDER , ADDRESS. TEL EPHONE NUMBER <br />SIGNATURED q- j DATE <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 />I <br />_TYPE <br />A/C —A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />, <br />SHOWER <br />I <br />UNIT HEATERS — B.T.U. M <br />KITCHEN SINK 8 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 />_ <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />I <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />; <br />SINK (SERVICE — BAR. ETC.) <br />I <br />GAS RANGE <br />_ <br />GAS PIPING <br />EXHAUST FAN <br />_ <br />Y <br />SUB TOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PI AN CITE/ K <br />EEF /, <br />RECEIPT N0. <br />^MBE <br />( fYJ <br />Y//11/n <br />USE ZONE <br />LOr AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />l <br />I IYES I NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BIIX:R/i�r <br />I <br />UNITS <br />yr_I=n %1 . TV <br />✓✓!! 1 <br />OCCUPANCY <br />NO DF STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />I <br />� <br />f•I• <br />Na <br />)IYES M NO <br />ADDITIONAL PLANCHECK <br />I <br />i <br />FIRE ALARLM� RED n <br />REASON <br />I�J <br />�'ZAC/Et�C7 <br />OTHER <br />F IRF SPRINK I E. R RFO'0 <br />REASON <br />I v lU <br />STALE BUILDINf, SIIRCIIARf,E <br />TYPE or coNsr <br />rinNs nrrnovrn By <br />CITY OF EVERETT <br />ruBiw WORKS <br />Nam' <br />T%M <br />LOCAL SALES <br />lP' lei <br />TAX CODE IS 3105 <br />TOTAL <br />a3 I fl <br />DATE <br />