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,—I, <br />APPLICATIOA FOR COMSTRUCTiON PERMIT <br />CITY OF ERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT,RETT, WA 98201 •259-8810 <br />Fl DEMOLITION I I COMBINATION 1 1 BUILDING '-1 MECHANICAL PLUML AG I SIGN <br />PROJECT ADDRESS <br />_ a.93o A.) - t:✓ems t-E 9�0�0� <br />OWNER MAIL ADDRESS CITY ]m PRONE <br />GIYIa <br />ON� iiyc-\ E <br />TENANT <br />G L <br />ARCHITECT o n .,,IGNER <br />MAII ADDRESS <br />MAH ADDRESS <br />CITY <br />CITY <br />]m <br />]IF <br />PHONE <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />IF <br />PHONE STATE LICENSE I, <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE. <br />\ <br />{A LC• P a�o�_�_ <br />MAIL ADDRESS <br />/L <br />%s��, IFIJe <br />CITY <br />S F..cK <br />ZIP <br />i W IA- aoro 87, SZt� rl+IERAhTo <br />PHONE STATE LICENSE. <br />PLUMBING CONTRACTOR <br />CONTRACT 10E' ORK <br />00 <br />— <br />HEATING SYSTEM: I I GAS 1 I ELECTRIC I I_ _ <br />DESCRIBE WORK ANO��I(SOUARE FOOTAGE IN.VL�I�LVEO <br />�ATfO vI OQ' <br />CONTACT PERSON AND PHONE NO <br />(1 <br />ry <br />— — <br />- s7a-sip <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 WPETHER 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 REGULAI ING 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 />CONTRACTORS LAW 27 RFW AND 296.200 WAC, <br />X Q �7'7>C' -/ <br />PROPOSE USE or BunmNc <br />CiC <br />LEGAL DESCRIPTION OF PROPERTY SHOWN BROW ON ATTACH TWO COPIESI <br />LOT BLOCK or <br />PARCEL TAXI D NUMBER <br />CONSTRUCTION I CAN LENDER. ADDRESS, TELEPHONE NUMBER <br />SIGNA RE DATE <br />CITY BUSINESS I ICENSL NO <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-A/HNDLG UNITS -H.P. <br />BATHTUB _ <br />_ <br />FORCED AIR SYSTEMS - B.T.U. M E.A. <br />' <br />LAVATORY (WASF. BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS - B T.U. M <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />WATER HEATER <br />r <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />GASFIREPLACE <br />; <br />SINK (SERVICE - BAR. ETC.) <br />GAS RANGE <br />_ <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />�J <br />— <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SFTRACK <br />FEAR SETBACK <br />SIDE SETBACK <br />PI AN CHECK NLJ� BPji// <br />fFP <br />RECEIPT NO <br />I,]/ <br />USE 70NE <br />IOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />__— <br />I1YES 11 NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE Of BLOWN <br />rLIJMBINO <br />I <br />UNITS <br />MECHANICAL <br />—{ <br />OCCUPANCY <br />GROUT <br />NO OE SIOREE <br />OCCUPANT IOAJ <br />BASEMENT <br />AYES 11 NO <br />FIRE ALARM RED <br />REASON <br />ADDITIONAL PLAN CHECK <br />OTHER <br />@qE SPRINKLER RED <br />REASON <br />,,TATE BUILDING SURCHARGE <br />I <br />I <br />TYPE OF COkST <br />PLANS APPROVED BY <br />CITY OF EVF.RETT <br />rumlr, wones <br />LOCAL SRLFS <br />-- <br />TOTAL <br />I <br />DATE <br />TAX CODE IS 3105 <br />r <br />