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APPLICATII.�I FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET • EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION fl COMBINATION Il BUILDING f� MECHANICAL f� PLUMBING rl SIGN <br /> PROJECT ADDRESS E , L��/6✓rST,% �'9 ��f <br /> // /6fF/% l2A� Y</�9Y S � <br /> OWNER MRILA�URESS _ � I � . Cltt 21P fNONE <br /> T4' LG�'�GS��d1'� �j'�I IC�til'P 1.� �VCXG-�'��B �J�J"7 - ��7 D <br /> 7ENANT� /� MRILPDDRE55 CITV IIG PMONE <br /> ARCHRECT OR DE51 NER MAILAODFE55 CITY ZIP PHONE <br /> GEN LCONTRACTOR MAILA�DRESS CIN ZIP PHONE STATELICENSE� <br /> � //�/"'�i <br /> MECH NIChLCONTRACTOR lAAILA�ORESS CIN 21P FHONE STATELICENSEI <br /> PLUM6INGCONTRACTOR MAII.ADDRE55 Cltt ZIP PHONE STATEUCENSE� <br /> CONTRACiPRICEOF WORN HEATING SYSTEM: f�GAS 17 ELECTRIC ❑ <br /> DESCRIBEWORKANOSOUANEFOOTAGEINVQLVEO CONTACTF F ONAND�I}10N�].3�f��/ ���-�� .�` 1(A) <br /> �V� � 't'\ `C/�n _�� �� // L " - �l> Nr% <br /> K/' <br /> T6�.d 3�'3-�9� � _ <br /> n/�� /� /'' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED ?HIS <br /> t /�;fAtil� �� Gf LO �1/"�%'1. �''-f���'�-� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> PROPOSEO.USEOF UILDING � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ��'pG��✓ C � �� G��~G- � WORK WILL BE COMPLIED WITH WHETHEA SPECIFIED HEREIN OR <br /> LEGALDESCRIPTION ROPE V�SHOWNBELOWORATTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ar BLOCK cr AUTHORITY TO VIOLATE OR CANCEL THF PROVISION OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING 6UNSTRUCTION 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 1827 RCW AND 296200 WAC. <br /> PARCELTA%ID.NUMOER <br /> � �l-c�-�o - nooa- X ,�, �j��C�a�, a �. <br /> CONSTRUCTIONIOAN LENDER.A�DRESS,TELEPHONE NUMBER <br /> 51 ATUP DAiE <br /> GIN SME55 UCENSE N0. <br /> PLUIlBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. ' <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER UNITHEATERS—B.T.U. M ' <br /> � � <br /> KITCHEN SINK&DISP i CLOTHES DRVERS ' <br /> � VENTILATION FAN ' <br /> DISHWASHER i <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER i WATER HEATER ' — <br /> URINAL <br /> � WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) �_ <br /> � FIREPLACE INSERT(WOOD BURNING) ' <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS � GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � — <br /> ; EXHAUSTFAN ' <br /> � � <br /> � � <br /> � T <br /> t <br /> � - <br /> SUB TOTAI S ; SUB TOTAL 5 i <br /> PERMIT S PERMIT S � <br /> � <br /> TOTALFEE S ' TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN REAR SET�hCK SIU[SETDACN PIAN CHECR NUMOEH FEE <br /> RECEIPT NO. <br /> </L�� %� <br /> FEES VALUATION FEE <br /> USE20NE LOTAREA VACANi51TE 7 � <br /> ❑YES ❑ NO pUILDING / � ��� � <br /> i' <br /> HEIGHTLIMITATION UO.SFOWELLING SIZEOF9LDGRI. � <br /> 300� PLUM6ING <br /> ; <br /> OCCUPANCV NO OFSTONIES OCCUPANTLOAD UASEMENi MECHANILAL � <br /> GROUP 1 Q � � <br /> _1 CJ ❑ves yr(o � <br /> AODIPONAIPLANCIIECK � IF i"' � <br /> FIRE ALARM REO'0 RFASON � <br /> NV OTI/ER � <br /> � <br /> FIRE SPPINNLER REO'D HEASON � , <br /> ^/ STATE BUIL�ING SURLM4RGE � <br /> / i_ <br /> '■ � i <br /> TYPEOFCONST PLANSAPPROVEOBV CITYOFEVERETT P�BLICWORNS � <br /> �j Q.•, LOCAL SALES � ; 1 � 'i <br /> �_ onie I 1- 2.� -S� TAX CODE IS 3105 TOTAL I4 - ' - <br />