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� � <br /> APPLICATI�.N FOR CONSTRUCI .ON PER�IAIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR 5'fREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION pd BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS �sd9 � �•o����Y �`e�,p �f �� � y�ol <br /> OWNEfi NAILADDRE55 CITY ZIP PNONE <br /> �d4�Q r�% �e y.-i i��z L��-es'e f� ����1 3� 3 - `�! S/ <br /> TEN�NT MAILqUDRES$ Cltt ZIP PNONE <br /> t�ll.�,;�v^c� N�»t :�� z �lie� ,P�'� '�'1$zol �i0 3 ` 9/,�� <br /> PRCHITECTORDESIGNER MAILA�DRE55 CITV 21P PMONE <br /> GENERAL CONTPALTIXi MAII A�DRE55 GTY ZIP PHONE STATE LICENSE Y <br /> MECHANICRLCONTR�CTOR MAILADURE55 CITY 21P PMONE STATELICENSE� <br /> PLUMBINGCONiRRCTOR 61AILRODRE55 Cltt ZIP PHONE SIATELICENSE• <br /> CONTiUCTPRICEOf WORK n� � � <br /> �lc ��' ����,�SU " HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> �E$CRIBE WORN ANO SOUARE FOOTAGE INVOLVED 7 CONTRCT PERSON AND VMONE NO. <br /> �2 f* �Y F+� c/r 6 f <br /> � r a �f r� r� C"r o a ,r <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P V APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEOUSEOFBVILDING�� � C _ S r=� yyORKSWINL BE OMPIIED WITH WHETHER SPECIFEDHHEREIN OR <br /> LEC��LDESCRIVTIONOFPROPERTY�SNOWNBELOWORATTRGHiWOCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �o� ��f�BLOCK '��y or HI I�Dn ' R OTHER 3TATE OR LIOCAL L W REGULATING CONSTORUCITOION OR THE <br /> Ato/ '�c/� f a �- Q✓e /pt PERFORMANCE OF CONSTRUCTION.THAT 1 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 /> PARCELTW(I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> �rrsy � -�iy -b�, y- oo� � ��/J�� � <br /> CONSTRUCiION�Ol1N LENOER.A�DRE55.TELEPHONE NUMBER X��p 'f(.{Lf7'� ��' 2 �' �� <br /> n� y� ..� SIGKATJRE � UATE <br /> qTV BUSINE55 uCENS'c NO. <br /> PLUMBIN6 MECH0.NICAl <br /> NO. TYPE OF FlXTUPE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A!C—FVHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ; <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> —T <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD i <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT�WOOD BURNING) � I <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � I, <br /> SINK(SERVICE—BAR.ET0.) � GAS RANGE � �I <br /> GAS PIPING ' <br /> i EXHAUSTPAN � <br /> � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL $ � SUB TOTAL $ � � <br /> PEFMIT S i PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE OhLY: <br /> FRONTSETBRCK ' PEARSETBRCK / SIDESETBACK / PLONCMECN_NUMOER FEL /O RECEI�ONO. � ^/ <br /> 7� � ' ' ny <br /> useiorve IOT�REA vncnrvrsire / FEES VALUATION FEE <br /> _� .. �� nves �fno euaoiNo 20�«y r � <br /> � — <br /> HEIGIIT LIMITATION �.O OF UWLLLJNG SIZE OF OLUGRI. � <br /> UNI75 PWMOIHC � <br />� 2��0 s.f ��IL — <br /> GCCUPANCY NO.OFSi0pIE5 IX.CUPRNTLO�O BnSEMENT M[CN�NICAL ( <br /> �� ❑VES C7 NO � <br /> P�DIT10NRl PUN CIIECK � <br /> NPE AUPM REO'� REASON . �_ <br /> i <br /> OTII:R j <br /> FIRE SPRINNLER REO'0 RE�SON i _ <br /> STATL�UILOING SIIPCHARGE i/ <br /> TYPE Of CONST PLANS APPRp VE09V CITY OF EVERETT FUBLIC WORNS � <br /> �J N LOCAL SALES � <br /> - �1 opTE 4 TAX CODE IS 3105 70TAL '� ' I r- ) <br />