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� �. <br /> APPLICATIL.� FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> O DEMOI.ITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECI'ADDRESS <br /> �9/ 9 �✓-Pi���� /,U u <br /> OWNER MAILADDRE55 CIIY ZIP PHONE <br /> ��7� <br /> TENANT � MAILP DDRE55 LIN ZIP PHONE <br /> �a"' 'i� .37�(��� � <br /> ARCHITECTORDESIGNER MAILADDRE55 CITV 21P PHONE <br /> GENERALCON�RACTOR MAILA�ORESS CITV ZIP PHONE STATELICENSE� <br /> MEC�L(:ON ACTOR M A RES$ � CIN ZIP Pk10NE STATE LICENSE� <br /> l�'i/lr V �l� c L/\ <br /> PLUMBING CONTR TOR MAILADDRESS Cltt ZIP PHONE STATE LICENSE� <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE FOOTdGE INVOLVED CONTACT PERSONANO PHONE NO. <br /> �v� <br /> � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> vaoaoseo OFBUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIONOFPR �sHo � �LOWORATfACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ecK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEF 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 /> PRRCELTA%I.D.NUMBER CONT RS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTiiUCiION LOnN iENOER.PDDRE55,TELEPHONE NUMBER i�J(/�[ I�-I�7 -�� <br /> SIGNA RE DATE <br /> CITY BUSINE55 LICENSE N0. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FO(TURE OR ITEM FEE '�10. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. `_ <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATEFS—B.T.U. M ; <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRA1' ; RANGE HOOD i <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR 7RAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUST FAN � <br /> ' <br /> i � <br /> � T <br /> I � <br /> SUB TOTAL $ ' SU6 TOTAL $ � <br /> i <br /> PERMIT $ � PERMIT S i ' <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIOE SETBACK PIAN CHEC¢NUMQEa� FEE�'^ RECE��%O�� <br /> ��lli�%5� V <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> i <br /> ❑YES ❑ NO BIIILDING j <br /> HEIGHTLIMITATION NO.OFOWELIJNG SIZEOF6LDGRI. � <br /> UNITS PLUMBING � <br /> GROUP NCV NO.OFSTORIES OCCUPANTLOAO BASEMENT MECHANICRL j � <br /> ❑VES ❑ NO � <br /> FIREAURMREO'D REASON AD�ITIONALPLANCHECK � <br /> OTHER 2(� /F�J � D��V <br /> FIRE SPRINKLER REO'D REASON � <br /> STATE BUII➢IN SURLHARGE i <br /> 7YPE OF CONST. PLANSAPPROVFD BY CITY OF EVERETT PUBLIC WORKS i <br /> ;�M LOCAL SALES ; <br /> DATE I 2 TAX CODE IS 3105 70TAL � ,/ �_ <br /> Q�J l l7 � <br />