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APPLICATIO.i FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> 4a Z-� �� � <br /> OWNER // MAILADDRE55 Cltt 21P PHONE /S� _�� / <br /> J�-�'L[7i'ri(C9J i/ �i <br /> % � <br /> iENANT MAILAODRESS CITY ZIP PHONE <br /> QCRl- o �.SuqiS <br /> ARCHITECTOFlDESIGNER MAILADORE55 CITY ZIP PHONE <br /> GENEflALCONTRACTOR MAILAOORE55 GITV ].IP PHONE STATELICENSEN <br /> U-�D TN�'h�4S CPan S'ELcC[�'t'�lJ� <br /> ME::HANICALCONTRACTOR MAILADDRE55 CIN ZIP Ph10NE STAtELICENSE• <br /> PLLIMBING CONTRACTOR MAILAUDRE55 /J CIN ZIP PHONE STATE LICENSE I1 <br /> �.SeR.xlArtiYcsT � °¢� PD' 1 Z'2-� �M1�'� t�0 ✓I <br /> CONTAACT PRICE OF WOR� <br /> � � HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBEWORKANOS�l1AREFOOTAGEINVOWEO CONTACT ERSONAN�PII0NEN0. <br /> —a6 <br /> . <br /> Y15�-� S'w � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING 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 /> LEGAIDESCRIPTIONOFPROPEflTY�SHONMBELOWOflATTACHTWUCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PfiESUME TO GIVE � <br /> �or BLOCK_ OF 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 /> PARCEL TAX I.D.NUMBER CONTRA TO 5 LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCiION�OAN LENDER.ADOFE55,TEIEPHONE NUMBER X Y'I I'�/ W ��6� <br /> SIGN �� ��/ � TE <br /> ♦ <br /> -U�l <br /> CITY BUSINE55 LICENSE iJO. , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> '� BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' ' <br /> i <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYEHS � <br /> DISHWASHER i VENTILATION FAN ! <br /> LAUNDRY TRAY �tl� ' RANGE HOOD _� <br /> CLOTHES WASHER � WATER HEATER � <br /> .� URINAL ' WOOD STOVE ' <br /> .-- DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> �— FLOOR DRAIN � FIREPLACE INSERT(WOOD BUFNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> i � <br /> �. ; FXHAUST FAN � <br /> � <br /> W � <br /> i <br /> i � <br /> i <br /> i � <br /> SUB TOTAL $ ' SUB TOTAL $ ; <br /> � <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> PRONT SET9ACN REAR SET�ACN SIOE SETBACN PLAN CHECN �}t}I�Ei�j� FEE RECEIPT ft0. <br /> O 30 <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> i <br /> ❑YES ❑ NO BUILDING i � <br /> HEIGHTlIM1TATI0N NO.OFDWEL4NG SIZEOF9LWR.1. � <br /> / � ' <br /> UNITS p�UM91NG � <br /> OCCUPANCV NO.OLSTOPIES Of:CUPANTLOA� BASEMENT MECMANICAL � I <br /> GROUP <br /> UYES Ll NO j <br /> FIREpIARMREO'D AEASON AD�ITIDNALPLANCHECK � <br /> � <br /> OTHER � <br /> FIRE SPRINKLER REO'D REASON i <br /> S7ATE BUILDING SURGHARGE � <br /> TYPEO�CONST. PLANSAPPROVEDBY CITYOFEVERETT �UBLICWORKS i <br /> LOCAL SALES I ; <br /> DAiE TAX CODE IS 3105 70TAL � <br />