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APPLICATION FOFt CONSTRUCTiON PERMIT , <br /> CITY OF EVERETT• BUILDIhG DIVISICN � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259•8810 <br /> i7 DEMOLITION �l COMBINATION I l BUILDING I { MECHANICAL I� PLUMBING fl SIGN <br /> PROJECT ADDRESS � { <br /> � <br /> � <br /> ownea r�mi nuoness cin zm ri�ove <br /> �> i.1FmTr� i� � e�.m,��r�,�, �, ue r G Ka-oi �u3.� r �� <br /> TEN�NT MAILqDDtiE55 LIiY 21P PHONE <br /> ARCHITECTOAOESIGNEA MFILADORE55 GITV 21P PHONE <br /> GENERALCONTRACTOF MFILnUDRE55 CITV ZIP PIIONE FTATELIL'ENSE� <br /> RIECHANICAL CONTP4CTOR MAII,qUDRE55 CIN 21P PIIONE STATE IIGENSE r <br /> S�0.t,'�n���P r•rn��yM1�jniic.�-r�L ; v.�CJi2.c(-�u,���t,1Je�C 9S�7U► �3 �� �3 <br /> PLUMBINGCONTRFC70R ' NAILpppRESS CIiY 21P PNONE � ST�L�EN E���� <br /> CONTRRCT PRICE OF WO <br /> �� /. L HEATING SYSTEM: S�GAS Cl ELECTRIC I-7 <br /> DESCRIpE WOflK ANO SOUARE FOOTAGE INVQlVEO CONTACT FEPSON AND PHONE N0. <br /> 1l�t C L/1(' R f <br /> Z7 <br /> I HEREOV CERTIFV THAT I HAVE READ AIJD EXAMINED THIS <br /> �ROPOSEO UFE OF BUI OING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ���A p .�Am1 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br /> LEWLDESCRIPTIGN' FPROPERtt�SHOWN9EL YOqATTqGHiIVOCOPIES) NOT. THE GRANTING OF A PFRMIT DOFS NOT PRESUME TO GIVE <br /> �or e�ocK oe AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEPTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEITA%I.D.NUMBER CONTRACTOPS LAW 1827 RCW AND 296.2001YAC. <br /> GONSTRUCPON LOr1N LENDEN.ADDRESS,TELEPIIONE NUMBER xG�l/(/U PnCfA • / L D�/ ��v <br /> $IONA RE b "J <br /> CITV�USMGSS LIC[NSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FII(TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. i <br /> BATHTUB ; / FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH OASIN) HEAT PUMP ,— <br /> SHOWER � UNIT HEATERS—�.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ' <br /> DISHWASHER � VENTILATION FAN i <br /> LAUNDRY TRAY ' RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN ; tdETAL FIFiEPLACE(WOOD BURNING) i <br /> FLOOR�RAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERVICE—OAR, ETC.) GAS RANGE <br /> GAS PIPING � <br /> � EXIIAUST FAN ' <br /> � <br /> � , <br /> _ � <br /> i <br /> SU�TOTAL S � SUB T07AL 5 � <br /> � <br /> PERMIT $ � PERMIT S —� <br /> TOTALFEE $ i TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACK REARSETOACK SIDESE7�ACN PLANCHECKNUMF3ER fEE RECEIPTNO. <br /> us�zoNe ioranen VACANISIiE FEES VALUATION FEE <br /> nvEs n r+o eunoiNc ; <br /> � <br /> HEIGHTIIMITATION NOOFOW[LLING SIZEOfBLDGRI. — i <br /> UNI15 <br /> PWt.1��NG � <br /> � <br /> OCCUPANCY NO O�StORIES OCCUPANLLOAD OASEMENi —� <br /> GROUP lAGCMANICAL i <br /> f]YES Cl NO � <br /> i <br /> FIRE ALARM REO'� REASON ADDITION�L FUN CNECK � <br /> OTIIEP i <br /> FIRE SPRINNLER REO'0 RERSON <br /> STATE BUILDIN6 SlIRC11ARGE � <br /> iVPEOFCONST PLANSAPFROVEDOV CITYOFEVERETT �UBUCWORKS � <br /> LOCAL SALES ' <br /> __ DATE TAX CODE IS 3105 TOTAL j <br />