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�.. ,. <br /> APPLICATIG.�1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> r7 DEMOLITION fl COMBINATION ❑ BUILUING ❑ MECHANICAL PLUMBING C7 SIGN <br /> PROJECT ADDRESS C� � L <br /> owraEa �n �__ /7�'Q— �� �D� <br /> M�LADOfiE55 Cltt ZIP Pf10kE <br /> �.�r,e�, Sa /ARAv,�¢s 3/ lGLr�+crrE' �ie�rr !!',q ��o/ 3B g54�'� <br /> TENRNT MAILADDRESS Cltt 21P PHJNE <br /> �NnA2��� I�c�A�rF_k Fv�rT" .�1r�ru.g`. 'Tawcc2 � 7� F��,Q <br /> ARCIIITECTOflDE51GNER MAILADORESS LITY ZIP PNONE <br /> GENERALCONTRqCTOR MAILADOBE55 GITV 11P PIIO!!E <br /> STATE LIGENSE Y <br /> MECHANICALCONTRACTOR MAILADDRE55 LITV ZIP Pk10NE ' <br /> STATE LICENSE� <br /> PWMBINCaCONTRqCT MAILADORE55 CITY 21P PHONE <br /> J/y� STATE LICENSE• <br /> CONTRACTP EOF WORK , �� �7'77K� LA/VI VM�'„ �.�A/ q <br /> ._r..— <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> DESCRIBE WORK ANO SOl1ARE FOOTAGE INVOLVEOn CONT T PERSOHAN�PHO•1E NO. <br /> 5 /` �d�� <br /> � LOD <br /> I HEREBY CERTIFY THAT I IiAVE READ AND EXAMINEO TN�S <br /> PPOPOSED USE OF fi111LDING APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRLDESCPIPTIONOFPROPERTY�SNOWNBELOWORATfACHTWOCOPIES) WORK WILL BE COMPLIED WITH VJHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DGES NOT PRESUME TO GIVE <br /> �or e�ocK 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 AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH ' <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPCEL TA%I.D.NUMBEP CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSttiUCT10N LORN LENOEA.ADDPESS,TELEPIIONE NVMBER �// �Dr n�_ C'/ <br /> X � <br /> SIGM/U��� �/—�—� OAtE d Y �� <br /> CI7V BUSINE55 LICENSG NO. <br /> PLUMBING MECHANICAL <br /> NO• TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. i <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) ' <br /> � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN S�NK 8 DISP i CLOTHES DRYERS ' <br /> i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAV ; RANGEHOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> UR�NAL � WOOD STOVE i <br /> DRINKING FOUNTAIN � METAL FIREPLAGE(WOOD BURNING) ' <br /> i <br /> FLOOR DRAIN � FIREPLACE INSERT(N'OOD BURNING) i <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING � <br /> � EXHAUSTFAN � '� <br /> i � <br /> � � <br /> � � <br /> i T <br /> 1 <br /> SUB TOTAL 5 i� SUB TOTAL $ � <br /> i <br /> PERMIT $ ,OD PERMIT $ , <br /> TOTAI FEE 5 �O(7 TOTAL PEE $ � <br /> FOR OFFICE USE ONLY: <br /> FBONTSETI3ACK REARSETORCN SIDESETBACK FLANCIIECKNUMBER/ FEE RECEIPTNO. <br /> �l� <br /> usezor+e LOTAREA Vf.CAM5ITE FEES VALUATION FEE <br /> ❑ves ❑ r+o aw�oiNc �— <br /> HEIGHTLIMITATION NO.OFOWELIJNO SIZEpFOLDG?I. <br /> i <br /> UNITS <br /> PLUMBINO i <br /> � <br /> OCCUPANCY NO.OFSTOFIES OCCUPANTLOAU BASEMENT MECHANICA� <br /> GROIIP <br /> ❑YES ❑NO <br /> FlREAURMREOD REASON PDDI110NALPLANCHECK i <br /> OTIIER I <br /> FIRE SPRINKLER REO'D REASON <br /> STATE OUIL�INO SMCHARGE i <br /> TYPEOFCONST. PIANSAPPROVE�BY CITYOFEVERETT PU�LICWORKS � <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 TOTAL ; <br />� <br />