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APP��C�ION FOR CONSTR�' ,^.TION PERMIT <br /> CITY OF EVERE'IT•gUILDING DIVISION � <br /> 3200 CFDAR STREET• EVERETT, �'�q g8201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 6�I MECHANICAL CJ PLUMBING ❑ g <br /> PROJECTA�JURESS <br /> r2'T o'7 co�ta—� EvFe�.�.tT,WIi <br /> OWNER MN�ADORE55 <br /> CIIY i1P PNONE <br /> .a. µ . z-,3 � w ET►�aE Ev 9,�?�/ <br /> . TEN�INT MAILADDRESS ����� � <br /> Z�P PNONE <br /> �`�F �1oJu.c-tc �.1c�.lpc� <br /> ARCHIffGTORDE5IGNER MAIIADDRE55 <br /> CTM IIP PHONE <br /> GENERALCONTAACTOR MRILADDRE55 <br /> CI7V ilP PMONE STATELICENSE� <br /> AIECHMlIGAICONTRACTOR MRIUDORESS <br /> Pi°`T`''�'r ��r Z�P PHONE STATE UCENSE� <br /> F��c+¢ A:cs�-zc�cw..l 2c�o4-�a, q.8'4''fue c�. � Tv�cae�tA .wh 98 9z�.-2aYc <br /> � PIUMBIN�CONTRnCTOR M�II,AppqE55 ��"� � p�'�RIFlrCqY�f- <br /> ��ry Z�P PHO4E STATE LICENSE� <br /> � COHTMCTPp�LEOFN'ORK � <br /> � �"�`�"�`-v ��'-�"�`�� (-�„�.� HEATING SYSTEM: ❑G,4S O ELECTRIC <br /> OESCRIBE WORK ANO SOUARE FOOTA6E INVOLVED �— <br /> OO l..o C.l.T �y CONTACT PERSON AND PI/O4E N♦O. <br /> � SPWr.i1Gt�(�. �I+oTfL.l1d \�QNN1S J. �cf�cYC� <br /> �� r��.�„- ��._,��.,�,�s C2.�c� ) �2v• 2290 <br /> I HERE@Y CERTIFY THAT I HAVE READ AND EXAMINED THI; <br /> reoroSeo use oF sm�oiNc � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AL� <br /> �F�« PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE 01 <br /> LEGAIDESCRIPiIONOFPROPERTY�SHDYMBEIOWORATiACH7WpCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> �oT NOT. THE GRANTINQ OF A PERMIT DOES NOT PRESUME TO GIVE <br /> B�ocK oF AU7HORITY TO VIOLATE OR CANCEL THE PqOVISION OF AN1 <br /> OiHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOqM THE WORK FOR WHICF- <br /> APPLICATION IS MADE AND I COMPLY WITH THE ETATE <br /> PARCEITA%I.D.NUMBER CONTRqCTORS LAW 1827 RCW pND 296200 WAC. <br /> CONSTRUCTIONLOMlLENOER,ADDRESS.TELEPNONENUMBER x / G _�� � ��,Z <br /> SIGNRt11PE ' � g_�� <br /> ___c24 v 9 � OATE <br /> CITV 9USINE55 LICENSE NO. <br /> PLUMBIN� <br /> NO. TYPE OF FUCTURE OR ITEM MECf1ANICAL <br /> �E N�� TYPE OF flX7URE OR ITEM FEE <br /> WATER CLOSET(TOILEn � A/C—AMNDLG UNITS—H.P. <br /> BATHiUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) HEAT PUMP ' <br /> � <br /> SHOWER , <br /> ' �1NIT HEATERS—B.T.U. M , <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS <br /> DISHWASHER � ; <br /> LAUNDRY TRAY VENTILATION FAN � <br /> CLOTHES WASHER ' RANGE HOOD i <br /> URINAL ' WATER HEATER � <br /> DRINKING FOUNTAIN � WOOD STOVE � <br /> � METAL FIREPLACE(WOOD BURNING) <br /> � , <br /> FLOOR DRAIN � <br /> ' FIREPLACE INSERT(N�OOD BURNING) r <br /> _ BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � <br /> ' GAS PIPING <br /> � EXHAUSTFAN <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � � <br /> i <br /> � <br /> � SUBTOTAL $ i ' <br /> PERMIT � SUB TOTAL $ � <br /> $ ' PERMIT $ � <br /> TOTALFEE S � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONt SETflRCK REAR SETBACN SIDE SETBACK PUN CNECN NUMOER <br /> FEE PECEiPT p.�� <br /> IISE 20NE � � r �� <br /> ��TAR� VRCr1NTSITE FEE VALUATION �/ <br /> ❑ves ❑ No FEE <br /> HEIGHt LIMRRION BUILDINO <br /> NO.OFOWELLINO 512EOFBLOfiRI. . <br /> UNIiS <br /> PLUMOINO � <br /> OCCUPANCY NO-0fSi0PIE5 OCCUPANTLOAD BASEMENT <br /> GROUP MECHANICQ <br /> ❑YES ❑ NO <br /> FIfiEAURMqEO'D HEASON ADOITIONALPLANCMECK _ � <br /> / � <br /> FIRE SPqINKLER RE�'D REASON OTHER L ) f <br /> � STATE BUILOING SURCHARGE � <br /> TVPEOFCpNST. PUNSAPQqOVE06Y CITYOFEVERETT PUBLICWORKS i <br /> �M LOCAL SALES � <br /> OATE I� 2 � TAX CODE IS 3105 TOTAL � <br />