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APPLICATI� I�OR CONSTRUCT JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR :iTREET• EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOLITION Cl COMBINATION i� BUILDING fl MECHANICAL f�,�LUMBING f-I SIGN <br /> PROJECT ADDRESS <br /> 3� � / ��% �7 C OL BY ��- <br /> O��.l I � 1Y�"/MC.`D4 /55 "—/�l 1.'�.i:C,L���rC� zir ��(J ^ �pHE <br /> �y� <br /> T[Nq ����/p��5S /I �� CITY ZIP �IIONE <br /> P <br /> ARCHITCCiORDE5IGNEli MAILADORE_5 Cltt pIP PHONF <br /> GENERALWNRtACTOR MAILADDRESS CtlY ZiP PNOYE STATELICENSEM <br /> MECIIANICALfONTR�CiOR MAILADDPESS CIN ZIP PHONE STATEUCEN$Et <br /> PLUM�INGCONiRAy�MAILAD� CIfY ZIP PHOhE STAiELICENSEY <br /> / C . <br /> / <br /> WNTIiACT PPICE OF WORk -- <br /> HEATING SYST�EM: ❑GAS Ll ELECTRIC Ll <br /> DESCRI�E WORN AND S�IIARE FOOTA6E INVOLVED CONTACT PER504 AND�NON@ 40. <br /> I HEREf3Y CERiIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PROVISIONS OF LAWS AND OaDINHNCES GOVERNING THIS TYPE OF <br /> WOP,K WILL BE COMPLIED WITH WHETHER SPECiFIED HEREIN OR <br /> LEGALDESCRIPTIJNOFPROPERTV(SHOWNBELOWOfiATTACIITWOCOPIES� NOT. THE GRANTING OF A PEFiMIT DOES NOT FRESUME TO GIVE <br /> tor o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofi THE <br /> PERFOR\IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER UF T OPERTY TO PERFORM THE WORK FOR WHICH <br /> APPL ATION IS DE ANU I COMPLY WITH THE STATE <br /> PARCELTAX 1.0.NUMBEF �%ONT CT 8. 7 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANLENDEF.ADDRESS.TELEPMONE NUMBGR _ - G � /;�> <br /> 51 �4TURE�� ��_/�_�� p _ <br /> CITV OUSING55 LICC SE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUNE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � q/C--A/HNDLGUNITS—H.P. r— <br /> BATHTUB ' FORCEDAIF.S'r5iEM5—B,T.U. M E.A. ' <br /> LAVATORYfWASH BASIN) � HEATPUMP , <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRI'TRAY ; PANGE HOOD ' <br /> � <br /> CLOTHCS WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BU'iNl�'3) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BL'RNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPIIJG � <br /> � EXHAUSTFAN ; <br /> � � <br /> � � <br /> � , <br /> _ � � <br /> SU�TOTAL 9 � SUO TOTAI 5 i <br /> PERMIT S � PERMIT S i <br /> TOTAL FEE 5 � � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> PRONT SETOACK REAR SETOACK 9UE SETBACK �LAN CHECN NUMOER FEE RECEIPT NO. <br /> usezoNe LOTAREA VqCANi51TE FEES VALUATION FEE <br /> nves n eo ow�owc 1 <br /> � <br /> HEIGHTLIMITA,ION NOOFOWELUNO SREOF9LIXiR.I � <br /> ur�its <br /> PLUNOING j <br /> OCCUPANCY NO.OFSIDNIES OCGUPANilOAO BASEIAENi � <br /> GROUP MECHANILAL <br /> ❑YES (7 NO ' - <br /> FIREAUPMHEOD RLASON ADDI➢ONALPUNCHECK � <br /> � <br /> OTHER i <br /> FlRE SPRINKtER REO'D PEASON <br /> � <br /> STATE BNLDING SURCHARGE � <br /> TYPEOPCOkST PLINSAPPROVEDBY CITYOFEVERETT PUbLICWORKS � <br /> LOCAL SALES • <br /> onTe TAX CODE IS 3105 TOTAL ; <br />