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APPLICATI�! FOR CONSTRUC'�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION i <br /> 3200 CEDAR STAEET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL f7 PLUMBiNG I-1 SIGN <br /> �ROJECT ADDRESS <br /> OVMER M�ILADDRESS Clttn l IIP/� PIIONE ` �, n <br /> r-�c�yc�_ ��Ne�+nooaEss ���G c l. 71�Jy tiVU� �l�r=��� . � A� _l �ar� <br /> t�1�� �Ya,eN a'��b C ot g �� l�l � � u�n�.r�rQI�-i-A q�J3� <br /> ARCNITECT OR ESIGNER MAIL ADOAE55 CITV �j_��� IIP �NONE �'l —��J <br /> ��e��� _�R-c�a .T.r�e ,�t, Cn���. �- �� �,�p��s►�o l'a � ���4 � <br /> GENERRL COr1TpRCTOR NAIL A�D�ESS Cliv 7.1i' P1104E S7aTE LICENSE� � <br /> 7 i� ��.C'or�-���e��c,� (oc�l �lN��ti� s�. Coa3-�GB� Tua,��ee�.3�-0,� <br /> MECHANICALCONTRRCTOF MRILADDAE55 CITY ZIP MONE G�L� STATFLICENSEi <br /> N����t►vu ���JC�c� l�► �n.o �I��,• �'r�vr, c�,a�l�fl� q� k�rw��a�:��r <br /> PLUMBING CON RnCTOR MPIL ADDR[55 GTV Z1P PNpNE STATE UCEHeE� <br /> CONiR� RICE Of WOFN <br /> �r HEATING SYSTEM: f_1 GAS ❑ ELECTRIC ❑ <br /> DESCAIBE WORK AND SOUAAE FOOtAGE INVOWED CONTACi PERSON RND PMONE NO <br /> �STAiL C`A � . � t� _ �,b. �-X t C 5- C7 <br /> - ►.�IF �tzs Eloe�z-c- I <br /> L��.�' r STAr ' UCt �-�'�AI�L��CS-I I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNGW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PPOPOSEDUSEOF ILDIN� PROVISION�OF LAW£AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL ,aE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LOESCFIPTIONOFPROPERTV�SHOWNBELOWOR�7TA�MTWOCO�IES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION Ofi THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPEFTY TO PERFOP.vI Tf1� �NORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPL`! !'JITH THE STATE <br /> PARCEL TAX I.O.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> (',pNSTRVCTIONLOANLENDER.�DDRE55,TElEPHONENVMBER X ��-, s✓._ ��j���J"'Y� ��.5��� <br /> SIGNPTURE � DATE <br /> GTY BVSINE53 LICENSE NO. <br /> PLUMBIN6 MECHAN�CAL <br /> NO. 1VPE OF FlI(TURE OR ITEM FEE N0. TVPE OF FIXTU^E OR ITEM FEE <br /> WATER GLOSET(TOILET) � A/C—NFINDLG UNIT!'i—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i HEAT PUMP �! � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL WOOD STOVE ' � <br /> DRINKINu FOUNTAIN � METAL FIFEPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLO'.N PREVENTEFS � GAS FIREPLACE i <br /> SINK(SERVICE—BAA,ETC.) � GAS RANGE ' <br /> GAS PIPING ' <br /> i EXHAUSTFAN � <br /> i ' <br /> �,,-� � � <br /> � ' <br /> SUB TOTAL $ � SU6 TOTAL $ � <br /> PERMIT S i PERMIT S � � <br /> y--�— <br /> TOTALFEE $ ' TOTA�FEE $ ' <br /> FOR OFFICE USE ONLY: — <br /> FRONT SETB�CN REAR SETBALK S�DE SETBpCN PLAN CHE NUM�ER FEE RECEIPT ND. <br /> �.�/3 <br /> USEIONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> f1YE5 C7 NO BUIL��N� � <br /> ^qGMi IIMIiATION NO O�OWELUNG 9ZE OF BLDG�fI. j <br /> VNITS PLUMBINp � <br /> OCCUPANCY NO.O�STO�ES OLC'1P�NTLOAD BM1SEMENT MECNANICRL I <br /> GROUP ❑YES ['I NO <br /> i <br /> FIREAIARMREO'D PERSON AOG�TION4LPUNCHECK � <br /> i <br /> OTHEF i <br /> FIRE SPRINKLEH REO'D AEASON � <br /> STATE BUILOIHG SVPCHAROE � ' <br /> iYPEOFCONST PIANSAPPROVEOBY CITVOFEVERETT PUBtICWORKS � <br /> LOCALSALES - ; <br /> DATE TAX CODE IS 3105 70TAL ' <br />