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�iPPLICATf"`N FOR CONSTRUC��ION PERMIT <br /> CITY OF EVERFTT•BUILDING DIVISION <br /> '""� 3200 CEDAR STREET• EVERETT,WA 98201 •259•8810 <br /> ❑ DEMiOLITION ❑ COMBINATION ❑ BUILDING 'MECHANICAL ❑ PLUMBING <br /> aOJECTADDRESS C7 SIGN <br /> ' Z`�-Ci �- � �I P�V L� \ �G � 1 <br /> OWNER MAILADDRESS � 1 �� � � <br /> LITY PNONE Z, - <br /> -1,�- �T � � Tl �A� _�LIY-(Z Z���1ZC�o�I3V �I (� � � ��-r-� �- <br /> 'E"""T AIWLAODPESS �l��fj C,S'�L�� <br /> CITY 2 j�p PNONE � <br /> � - � B AIX. .-I. , I—(�-i �- G � ZS-`� ' �7(of•rZ <br /> ��7EGTORDE51 ER MAILAODRESS -- <br /> ITr ZIP P ONE <br /> �i1I v 2i�,r 2 ��..-zn.5� � '� �+rr-�- . .L_�C���,�� -� � ��_�es-�� -K�< <br /> ' G NERALCpN7q�CTpq MAI�ADDRE.^,5 � <br /> � ��ry Z�P PNONE STATEUCENSE� <br /> 8��� l�� � ,r–� -, ..� . � ,� �. �}��,sc:�.—u c ez�� <br /> MECH�MC�ICONTiIA�pq MAIL�ppqE55 <br /> �'�i- ��, ^ ��A( �I,..,�� CITY STAT LENSE 1 <br /> =�P PNONE <br /> PLUMgINp Cpk}qA 7()q MAIL JIDDRE55 " I�I � �� �- I� /U s`�� c j�y�L-��,p ti,,A n ;�;� <br /> � ��TM z�P PHONE STATELICENSE� +�- <br /> LONTRACT RICEOFWp ^n ~ ` <br /> i�.� <br /> HEATING SYSTEM: ❑GqS O ELECTRIC ❑ , � <br /> DE BEWORI(AND Aq�pppTAOEiNV� l . � � <br /> � � LONT�CT VERSON ANO PHONE NO. <br /> ��. � <br /> '%� � - � 111-� � . �I- (�G <br /> , _� . <br /> , <br /> I HEREBY CERTIFY TFIAT I HAVE READ AND EXAMINED THIS <br /> r oro9Eo u5e o�drx3u � `�` ,� � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> /r�,�. �r S i{�l 5 PROVISIONS OF LAWS AND ORDINANCES GOVERNIN�THIS TYPE OF <br /> r� OESCqIPTipNpFpqppEqry�SHOWNBEIOWpqATTACHTWOCOPIES) WORK WILL BE COMPLIED WITH WHE7HER SPECIFIED HEFEIN OR <br /> toi NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO CiIVE <br /> ,_, ,. e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> ' OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE• <br /> _ ' PERFORMANCE OF CONSTFUCTION.THP.T I 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 /> PARCEITAX I.D.NUMBER CONTRA TORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTqUCT10N lOAN LENDER,ADORE55,TEIEPHONE NUMBER � A / y/�� <br /> J( 'l <br /> � SIGN�NRE OATE � <br /> CITV BUSIHE55 LICENSE NO. <br /> PLUMBINO <br /> NO. TYPE OF FlXTURE OR ITEM MECHANICAL <br /> FEE NO. TYPE OF F�XTURE OR ITEM FEE <br /> WATER CLOSET(TOILE� � A/C—A/HNDLO UNITS—H.P. <br /> BATHTUB � <br /> LAVATORV(WASH BASIN� ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> SHOWER ' HEAT PUM11P � <br /> KITCHEN SINK 6 DISP � UNIT HEATERS—B.T.U. M , <br /> � CLOTHES DRYERS <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY � <br /> � CLOTHES WASHER 1 RANGE HOOD � — <br /> URINAL WATER HEATER '�?"— <br /> DRINKINO fOUNTAIN � WOOD STOVE , <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> FLOOR DRAIN � <br /> ' FIREPLACE INSERT(WOOD BURNING) � <br /> BACKROW PREVENTERS ; GAS FIREPLACE <br /> _ �INK(SERVICE—BAR, ETC.) � OAS RANOE � <br /> � <br /> ' OAS PIPINO i <br /> � EXHAUST FAN <br /> i <br /> SUB TOTAL S � � <br /> SUB TOTAL S � <br /> PERMti S � PERMIT g , <br /> 70TALFEE S � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONt SETB�CK RE�R SETBa�K SIDE SETB�CK p <br /> UNLNECKNUMOER FEE RECEIVTNO. <br /> USEZONE IOTPREA VACANi51TE FEES <br /> VALUATION FEE <br /> ❑YES CI NO <br /> BUILDIN6 <br /> � OMTLIM�TATION NO.OFDWELUNp SqEOFBLDG?.1. <br /> UNIiS <br /> VLUM61N0 � <br /> t.��A�;Y (IO.OFSTOPoES OCLUPANTLOAO BISEMENT <br /> ��`�P MECH�NICAL <br /> O YES p Idp <br /> FIREAUHMREOU REASON ADWTIONALPLpNCNECK , <br /> FIRE SPRINKLER REO'D AEASON GTHER <br /> SiRE BUILDIN6 SURCHAROE � <br /> TYPEOFCONST. PUNSAPPROVEOBY ' <br /> CITY OF EVERETT PUBIIC WORKS ; <br /> LOCAL SALES <br /> D�TE TAX CODE IS 3105 TOTAL � <br />