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APPLICATII.N FOR CONSTRU�'e ,ON PERMIT <br /> CITY OF EVERETT• BU!LDING DIVISICN <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOUTIOPf }otLCOMBINATION i� BUILDING (� MECHAN;CAL i1 PLUMBING <br /> PROJECT ADDRESS /c� /� i 1 SIGN <br /> � / i, /fj 2cc�G�Wct�r <br /> � <br /> OWNER NAILADDPEpS <br /> ��C'L`/ � � i�ta�' L /� (� cm rm <br /> � � (��S �C /N /��ql A�' �M/� � ^ PHONE <br /> i MAI�qpORE55 �'��`�`/ I/^�� <br /> �r'1 CITY ZIP ��C-3JJ -���IJ./ <br /> ��- PHONE <br /> ARCHIT[CT OR DESIGNER MAILADDHE55 <br /> '� GITV ZIP PNONE <br /> GENERqLCONTRpCTOR MAILqDDRE55 <br /> �� C�TM Z�P PHONE STATE LI�ENSE� <br /> MECHANIpA�CONTAA�7pR MFI�AD�RE55 <br /> -C�" ��ry Z�P PHONE SiATE IICENSE t <br /> 7LUMBINGCONTqq�Tpq yIAILADDRE55 <br /> ��ry Z�� PHONE <br /> SThiE LI�ENSE� <br /> CONiRpCT PPICE OF WOPK <br /> � ��� �/$ � . � HEATING SYSTEM: ❑GAS !�ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE F00T' E INVOLVCD <br /> l �-.- - ..t CONTr1CTPERSONANDP110NE <br /> / <br /> ii R OtMu^ »,��Cn�� <br /> �'t' Cc�n., �f.'{� �'�rljui �C� I <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> nPROPOSE�USE Of BUILDIN� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> f"'�' C��'"�'T4 � PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGRLDESCFIPTIONOFPROPERTY�SNOWNBELOW�AiTACH ocoaiEsl �✓ORK WILL BE COMPLIED 1MITH WHETHER SPEGFIED HEREIN OR <br /> � �oT 3�-I � BLOCK_c'7 I 1-Do'� NQ h��-'��- �. NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> . �• AUTHORITY TO VIULATE OR CANCEL THE PROVISION OF ANY <br /> _PI V� U R�'�p� �I I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AU7HORI2ED BV THE <br /> � � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTy(�C. MBER ^ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> JC[�y� _G,11 _ CONTRACT RS LAK�1827 W AND 2g6.200 WqC. <br /> � 3— c�r�c�c� <br /> CONSTRUCTIONLOANLENDER,ADOBESS.iELEPHONENUMBER ������ <br /> �_ X � ? _1^ � <br /> SIGNATUPE _c_ � �� <br /> DATE <br /> PLUMBING CITV BUSINESS LICFNSE NO. <br /> N0. TYPE OF FIXTURE OR ITEM MECHANICAL <br /> / WATER CLOSET(TOILE� FEE NO. TYPE OF FIX7URE OR ITEM <br /> � FEE <br /> I BATHTUB �C—lVHNDLG UNITS—H.P. <br /> i <br /> LAVATORY(WqSH BASIN) ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> SHOWER ' HEAT PUMP � <br /> KITCHEN SINK 8 DISP � UNIT HEATERS—B.T.U. M , <br /> DISHWASHER ' CLOTHES DRYERS <br /> LAUNDRY TRAY � VENTILATION FAN � <br /> CLOTHES WASHER ' RANGE HOOD , <br /> URINAL ' WATER HEATER � <br /> � � <br /> DRINKING FOUNTAIN WOOD STOVE � <br /> FLOOR DRAIN ' METAL FIREPLACE(WOOD BURNING) � <br /> ' FIREPLACE INSERl'(WOOD BURNING) , <br /> BACKFLOW PqEVENTERS � <br /> SINK(SERVICE—BAR,ETC.) ' GAS FIREPLACE , <br /> ' GASRANGE � <br /> ' GAS PIPING � <br /> � EXHAUSTFAN � <br /> � � <br /> — , � <br /> i <br /> � � <br /> SUBTOTAL S 7 ^'� ' <br /> ' SUB TOTAL S � — <br /> PERMIT g � , <br /> TOTAL FEE 5 � PERMIT g � <br /> TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBAq: /�� q SFTP K <br /> �� � BRLK PIAN CHECK NUM FEE RECEIPi N0. <br />� VSE ZONE LOT AREA ���� �I�S� I�I I� <br /> I> �, 7_. VACANYESE EEES VALUAiION FEE <br /> ��� <br />, n No <br /> HEIGHT LIMIT�� ryO.OF DWELUNG SIZE OF BLDG/71. BUILDING �� �CS ��'_' _ <br /> uNirs � <br /> �t�� 5 f PWMOINO , �i <br /> O�C�UPANCY NO OFSICRIES OCCUPANTLOAO PASEMENT <br /> -O _4 ' " � � MEGHANICRL �Q I <br /> M1" '� /\l/� ❑YES ,�7�ryp <br /> FIRE AU9M PEO'D REASON ADDIiIONAL PLAN CHECK � - <br /> 2 ' <br /> FIRE S�qINKLER REO'0 REASON OTHER � �� <br /> i - <br /> STAIE BUILDING SURCMARGE <br /> TVPE OF CJNST � �/ <br /> r�nNs nrr�ov�o ov CI'!Y G�F EVERETT riwuc wonKs , <br /> �_N JN LOCAL SALES —•— <br /> onrE 3/��/9y TAX CODE IS 3105 TOTAL / � � _ <br />