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APPLICATI� FOR CONSTRUC ON PERMIT <br /> j CIl`Y OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> f� DEMOLITION fl COMBINATION fl BUILDING MECHANICAL il PLUMBING fl SIGN <br /> PRO�JLECTOADDRESS <br /> cos.bY x�uawE <br /> OWNEP MAILTDOPESS LIiY 21P PHONE <br /> 1��- INc Z�*�,��iarrKa� �- u,�e. q�c� <br /> TENANT T MAILADDRESS Cltt ZIP PHONE <br /> TUU,Y� l'�� <br /> A HITECTOflOESIGNER MAILM�PE55 CITV ZIP PHONE <br /> GENEML CONiR�ZrTOR � � MNLFD RESS C�IY 21P PMONE STITE LICENSE� <br /> � � �i11/1,�D.1�5 /'�t{r5j�L�ytral/ <br /> MECNt���Cl�� iN*qqCiOR MAILADDRESSr• CI7Y 21L'� PIIONE STATELILENSEI <br /> -�dl�—�IIt�L.�2�c+�37r.� �rrmt�lt4 ao�i�z „�W�.... �3t� <br /> PL MBMlGCON.R�CTOR AUIODRE55 CITY 21P ^7 PMONE STATELICENSE� <br /> � � <br /> . CO ACTPRICEOFWOfIK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑_ <br /> DE RBEWORKAN SOU�PEfOOT�GEINVOWED LONI�CTPEfISONANDPHONENO. <br /> ��A��� G��s 1 HEPEBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED US�Of BUIIDIub �S APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> : LEGALDESCRIPTIONOFPROPENTV�SHOWNBELOWIX1�TiRCHTWOCOPIGS) NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �ot eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTqUCTION OR THE <br /> PERFORMANCE OF CON6TRUCTION.THAT 1 AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROFERTY TO PEHFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> PARCELTAXI.D.NUM9EP CONTRACTORS LAW iB27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN IENDER.AOORE55,7ELEPNONE NVMBER X <br /> SIGN�TURE OATE <br /> dTV�USINESS LICEIlSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF FU(TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) i A/C—fJHNDLr UNITS—H.P. � <br /> � BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> � � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> _ KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENIILATION FAN � <br /> LAUNDRYTRAY ; RANGEHOOD ; <br /> CLOTHES WA3HER � WATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BUFNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—OAR,ETC.) � GAS RANGE —r— <br /> ' GAS PIPING ' <br /> � E%HAUST FAN � � <br /> -�— <br /> � i <br /> � � <br /> � i <br /> _ SUB TOTAL $ i SUB TOTAL $ ' <br /> PERMIT $ i PEHMIT S � <br /> TOTAL FC-E E � TOTAL FEE f ' <br /> FOH OFFICE USE ONLY: <br /> FRONTSETBACK RERRSETOACN SIOESETBALH PUNCIIEO NUMUER FEE RECEIPTNO. <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑YES ❑ NO pU1LDINa <br /> � <br /> HEICHTLIMITATION NO.OFOWEWNQ 512EOFOLDGRI. � <br /> UNITS p�UMBINO � <br /> OCCUPANCY NOOi5R1FIE5 OCCUP�NTLOAO BASEMENT MELIIANICAL <br /> GRWP <br /> OYES fl NO <br /> FIREAURMREO'D REASON ADDI➢ONALPIANCNECK <br /> OTIIER <br /> FIRE SPRINNLER REO'0 flEA50N <br /> STATE NUILDINO SURCIIARGE ( <br /> TVPEOFCONSL PlANSRPPROVED9Y CITYOFEVERETT PUOLICWOONS � <br /> LOCAL SALES , <br /> OATE TAX CODE IS 3105 TOTAL ' <br />