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APPLICATI,,�,N FOR �ONSTRUC�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> � 3200 CEDAR STAEET• EVERETT,WA 98207 •259•8870 <br /> IJ DEMOLITION ❑ COMBINATION ❑ BUILDING f� MECHANICAL O PLUMBING C7 SIGN <br /> 90JECTADDRESS �2_� _�a <br /> � � - 3 `L�c�� C� 'o FtvC_ l'n'� F�' <br /> OVMER MAIL�DDRESS CITY ZIP PHONE <br /> "Ti-1� r�.,,zv�.�.w C�. wza ��,.� A�� 5+��3600 sc-r.�-�e wn 9ti�oi loa 3 -���� <br /> TEMMIf M�IUODRESS � CITY 21P � PNONE <br /> � 'Corac_s lsv a..�i I��', ,SE�eti� P�E. SeaRz-� wA9 �iai !ti'�?- L�`l3Co <br /> 11RCNrtECTOppE510NEN M/JL�DURE55 CIiY ilP PHONE �Qu�r,fL3� <br /> �,.�e nX�z_ (� ��NSTe � .non� S ao ti7z-+.4-uc-s r"sc nrr� wa 9€�oi ,SZ�S'��p�J .�,.`. L <br /> OENERALLONTR�CTOR MAI�ADDRE55 �IiY ZIP PMONE } 1� STATEIJCENSE�* ' <br /> N E��.nn;���� Co�P taa� �r�� �a UE ►J . t«,��,�`�.�1 �i`603� t:lr-rtvw�e,�z��n�T <br /> MECMANIGLCONTRACTOR MAILADDRESS Cltt 21P PNONE STATELtCENSEr <br /> ���5� C o .ti..P �., oc �.�A�u . �-z-r��- e�3,, �E ��� ���� <br /> MAILAOORE55 CItY 21P PHONE STATE LICENSE� <br /> CONiRACT PRICE OF WpRY <br /> -� pd HEATING 3YSTEM: ❑GAS O ELECTRIC O <br /> DE9CAIBE YIORK�NO SQUABE FOOTACE tNV WE� CONT�CT PEPSON�N�PHO'+F NU. <br /> T- � i l N� O t/ -�-1 — <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUIIDINU APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> , --�' WORK WILL BE COMPUED WITH WHETFiER SPECIFIEO HEREIN OR <br /> , , DESCPI{TONOFPROPEfliY�SHOWNBEIOWOFATTACHTYOCOFlES) NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�aK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> ' '� • OTHER STATE OR LOCAL LAW REOULATINO CONSTRUC'fION OR THE� <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNcR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE il <br /> P�RCELTA%1,0.NUMBER CONT ACTORS LAW 7827 FCW AND 296200 WAC. i <br /> CONSiRUCTON 10�N LENDER.J�DDRE55,TELEPHONE NUMBER x �. C ��C` � �V� C �(j L�/J� <br /> SION�iURE � `� D�TE� <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM FEE N0. TYPE OF flXTUR�OR ITEM FEE <br /> WATER CLOSET(TOILEn � A/C—AMNDLO UNITS—"P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—d.'fU. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP , � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RAN6E HOOD ; <br /> CLOTHES WASHER � WATEF HEATER � <br /> URINAL ' WC00 STOVE � <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASF�REPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RAN6E � <br /> � � ' GAS PIPINO ' <br /> i EXHAUST FAIJ � <br /> —�— <br /> � � <br /> — i i <br /> � i <br /> i � <br /> SU8 TOTAL S ' SUB TOTAL S � <br /> PERMIT S i PERN.�T $ i <br /> TOTAL FEE 5 � TOTAL FE� .o � <br /> FOR OFFICE USE ONLY: <br /> FROM SETBACK REAR SETBACN 9UE$ETB�CK PLRN GIECK NUMOER fEE RECEIPT N0. <br /> S�7 SZ� <br /> uSEZOr+E LOi�RE� vncnNiSiiE FEES VALUATION FEE <br /> ❑YES C7 NO BUIlDINO <br /> OHTLIMITAIION NO.OFOWELUNQ 512EOFBLOGR.1. � <br /> UNITS P�UMBINO <br /> CQ JAPICY NO.OFSTOHIES OCCUPANTLORD BASEMENT MECHRN�CRL <br /> _r <br /> ❑YES Cl NO � <br /> FIR[ALARMREOD REASON ADDITIONRIPLANCHECK <br /> � <br /> OTHEP <br /> fIRE SPPINKLEf1 REO'D REASON <br /> STATE BUIIDINa SURCHAROE I <br /> TYPEOFCONSL PUNSAPPROVEDBY CITYOFEVERETT PVBLICWORKS � <br /> LOCAL SALES � <br /> o�re TAX CODE IS 3105 TO7AL j <br />