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.5` l °l <br /> APPLICATII .V FOR CONSTRUC'. .ON PERMIT <br /> "' GTY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 �259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING MECHANICAL f i PLUMBING fl SIGN <br /> '90JECT ADDRESS �, � i - ; <br /> �: 1 (��l C�o1 �J��qve q ��ol ' _. <br /> OWNEfi AI�ADDRESS C�TV Z�P PMO4E <br /> LI_1D ,el� ��j` II��1 �1 �r.ti.C, n�� �� 'i+���i( QL,P �{I��r� <br /> TENANT MAILADDRE55 �ITY ) 21P FMONE <br /> �i! <br /> �1�_�z�,t�- `10 �l����.�•-_n,c�• _ '� �,Y,l . <br /> ARLNITEGTORDESIGNEH IAAILFODRE55 � �Itt Z�P PHONE <br /> GENER�ICONTHACTOR MAILADORE55 CITv ZIP P1104E STATEUCENSE� <br /> �1�_tn,; c� � Cr,��" �t'�C� �i�-aa,0 5 S-ec�_�'.� a 4' 1;4 <br /> MECNANICALCONTRACTOR MAILADDRESS CiiY 21P PIIONE STATELICENSE� <br />� �'I � , �D��.p�e�:�.t_n,. Lr�n � a�� a v�c! a �,t i� ' �`i4 ?q��-Z s!�-`�')Cv �et,�nc�2 �'LUl <br /> (,�'�!j� PLUMBINGCONTRApTOR MAILAO RE55 qiV ZIP pH�NE STATELICENSE� <br /> I;�' ;,'� � COYiRACT PRICE OF W RN <br />� ' � `� HEATING SYSTEM: Cl GAS ❑ ELECTHIC ❑ <br /> i ' DESC IBE�N i D�SOUARE FOOUGE INV LVEO <br /> LONTnGT PERSONAND PNONE N0. �,'` <br />� I.,.,v�,u �. T i T y�,�� .; 57 _-=,'1Cr - a�1I <br />� (4r,� .,n ' 't ���� �t1 n <br /> sr:�. <br /> ��`I•��i�. ;.� I HEREBY CERTIFV THAT i HAVE READ AND FXAMINED THIS <br /> � � , PP"�'SED USE OF ltUll v+c� APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> � a �,c � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � ' � � � ` WCRK WILL BE COMPLIED WITH WHE7HER SPEGFIED HEREIN OP <br /> i i� �, LEC�LDE�SC.N-IF��I�ONOFPROPERTYISM0IVNBELO OFARACNTWOCOPIES) NOT. TF;E GRANTING OF A PERMIT DDES NOT PRESUME TO GIVE <br />� 14�_-:--�;,; �ot_J_e�ocK ��S 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 AUTHORIZEO BV THE <br /> � t OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> f ���..' APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARf.ELTA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSiRUCT10N LOAN LENDeR.ADDRE55.TELEPHONE NIIMDER X_NQlr�C� ���(`�'��.� q^��`�� <br /> SIG MURE OnTE <br /> CITY BUSINE55 UCENSE N0. <br /> PLUMBINO MECHANICAL <br /> N0. TYPE OF FIXTURE OR IiFA7 FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(701LETi � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' i <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES ORYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; qANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) i <br /> _ FlOOR DRAIN � FIREPLACE INSERT(WOO�BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING � <br /> �� � � EXHAUSTFAN � <br /> � � <br /> � � <br /> _ � � <br /> � i <br /> SUB TOTAL 5 � SU�TOTAL 5 � <br /> PEFMIT 5 i PERMIT S /j i <br /> _ , <br /> TOTALFEE S ' TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK PEAR SETBACK SIDE SETBALN PLAN CHECK NUMBEA FEE RECEIPT ND. <br /> USEZONE � LOTAREA VACANTSITE FEES VALUATION FEE <br /> f1YE5 ❑ NO BUILDIN6 � <br /> '`GNT LIMITATION N0.OF DWELLINO 512E OF BLDG/TI. i <br /> UNITS P�UMBING i <br /> OG �CY NOAFSi0RIE5 OCCUPANTLOAO BASEMENT MECNANICAL � <br /> GR(r�� <br /> ❑YES fl NO i <br /> FIREAWiMREO'D REASON ADDIPONALPUNCHECK i <br /> OTNER � <br /> FIRE SPRINKIER REO'D PEASON � <br /> STATE BWLDINO SURCNMGE I <br /> TVPEOfCONST. PlANSAPPR0VED8Y CITYOFEVERETT FUBLIGWORKS ' <br /> LOCALSALES <br /> o�TE TAX CO�E IS 3105 TOTAL I <br />