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APPLICATION FOR CONSTRUCTION PERMI�'�w�� <br /> CITY OF EVERETT•BUILDINC UI'✓i;tON <br /> 3200 CE�AR STREET• Eb'ERETT, WA 98201 •259-8810 <br /> I I DEMOUTION I I COMBINATION Ix, BUILDING I I MECHANICAL I I PLUMBING f 1 SIGN <br /> PROJECT ADDRESS /� � n/�� �� <br /> ! �� <br /> UWNFR MRILRUUfIt55 CIIY IIP PHONE <br /> �FNANI MMLAOOqF55 CIIY ZIP FIIONE <br /> �RCNITECTORDESIGYER MMI�ODRE55 CiIY ZiP PNONk' <br /> GENERPLCONTFACiOH MAILROORFSS CIIY ]IP PIIONE SiATELICEN5E11 <br /> G,�L I��NT�2.c 5 /07�� E/EL�G�c6�( G/q✓ E✓"ZETT lUA9PZ0�/ �o ��J'/b0 LLVc.Vi->t 06'�DS <br /> MECNANICAICONTRACiOR MAIIADDR[55 � CIiY ZtV PHONE STFTELICENSEt <br /> J—� <br /> PWMBING CONTRACTOR MPII iIpDRE55 QIY ZIP PHONE STATE UGENSE I <br /> CONfRACI PeICE OF WORN <br /> HEATING �VSTEM: j$(GAS ❑ ELECTRIC ❑ <br /> U[SCRIBE WORN�ND SOUTRE FOOUGE INVOI VED GONTACi FERSON PND PHONE NO. <br /> .afaiN y2, tZ2 Pr- 2IL �an� Z9o- B/ <br /> �IPAC-� 365sQF-r .�coN���. 7Z8sQ � Go�z.vC �/SiiJc �0-9/00 <br /> /O%.4L. ISS�Sy'� FY I HEREBY CEflTIrY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW iHE SAME TO 8E TRUE AND CORRECT.AlL <br /> VfiOPOSED USE OF BUiIUING '/ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> SN� '� ti1/L h` Cs WORK WILL BE COMPIIED WITN WHETHER SPECIFIED HEREIN OR <br /> IEGA�DESC,Po/FT��N�OFFMJPERTT(SHCWNBELOWORAifFCHTWOGOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br /> tot �`�` eiocx._____oF Q���� A T AUTHORITY TO VIOLATE OR CANCEI THE PROVIS�ON OF ANY <br /> OTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CON�TRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERN TO PERFOPM THE WORK �OR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PAHCEL TNt I.D.NUMBER CONTRACTOR AW 1827 CW AND 296.200 WAC. <br /> CONSIRI,Ct10NLOANLENnDER.AODRESS.TELEPrfONENUMBER x I/� l�i�fi' �/L��T (� <br /> C�TV Pj^�K SIGNRTURE DAE � <br /> CITV BUSINESS LICENSE N0. <br /> PIUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) -�� lVC—A/HNDLG UNITS—H.P. ' <br /> Z BATHTUB � FOR(.ED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � �_ <br /> ,3 LAVATUFiV(WASH BASIN) i $ HEAT PUMP <br /> SHOWER -�' UNIT HEATERS—B.T.U. M ' <br /> � KITCHEN SINK&DISP i CLOTHES ORYERS � <br /> / DISIIWASHER � VENTILATION FAN ' <br /> $- LAUNDRY TRAV ( RANGE HOOD � <br /> / CLOTHES WASHER WATER HEATER _ ' <br /> �- URINAL �' WOOD STOVE � , <br /> $ DRINKING FOUNTAIN METAL FIREPLACE � <br /> �- FLOOR DRA�N -�- FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOWPREVENTERS / GASFIREPLACE lMcr,ac. � <br /> -�- SINK(SERVICE—9AR.ETC.) -�- GAS RANGE <br /> GAS PIPING <br /> i <br /> EXHAUSTFAN � <br /> � ' <br /> SUBTOTAL $ i SUBTOTAI $ i <br /> PERMIT g i PERMIT $ <br /> TO?ALFEE $ TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONt SETBPCK. �/ REAR SETBAf.�� SIDE 5�d��K PIAN GHECK NUM�?R FEE RECEIP�NO. <br /> //l/ O j/�`7.j �'� <br /> Ll' <br /> use?owe n io�naEn n �� vncnr:�si.E FEES VALUATION FEE <br /> l�' �„�J nres n r�o BUII.OING y ZZ 1 (/ <br /> r <br /> HEIGHT LIMITPTIO NO Of OWELLING 512E OF BLDG?J. � <br /> UNIiS /SSO fr� LN/I✓4 � PIUMflING � � <br /> b JF Ge�ncE. <br /> � <br /> p�qOUPANCY 1YJOFSi0HIF5 OGCUPANTLOAO BASEMENL � � MEGNANICFL I <br /> � V�I � flvES ifNO � <br /> �DDi�iON��PLr1N CHECK � <br /> FIH AUHM REdD AERSON <br /> OTHEH <br /> i <br /> FlRE SFHINKIER RF.O'U REASON "" <br /> STATE BUILDMG SVRCH/RGE i `J <br /> "IGEOFCONSi � PL�NSAVF110E�D19v CITYOFEVERETT Pl!9LICWORKS �C" <br /> la LOCAI SALES ; <br /> �'/.� oarF �' 2-�`7k' TAX CODE IS 3105 TOiAL ' <br /> _ I <br />