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APPLICATIG.J FOR CONSTRUCT. �N PER1111T <br /> CITY OF EVERETT•BUILDlNG DIVISION � <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION C! BUILDING ❑ MECHANICAL ❑ PLUMBING Cl SIGN <br /> PROJECT ADDRESS �" <br /> �i�.?5�'O�� � ��rra r 2�� <br /> OWNER M�ILAODRESS CITY 21P � PMONE <br /> ��oTDiJ� �Lz��aG-�x_4�>F�e�f� Ga�s 9�10� z s� v.�s� <br /> TENRNT MRILi10DRE55 CIIY ZIP PHONE <br /> C - — ,�i-n�,i'oi�ss <br /> ARCHITE� TO e SIGN �MAyI�LADDRES CITV IIP PHONE <br /> �� (iY/!/G G ��!„13� <br /> GENER0.COt{IJi� TOR NLRDDfiE55 CI?V ZIP PHONE STATELICENSEI <br /> 0.5 �p�G�'-ri <br /> MECH�NICALC0IJTAACTDR MRILADDRE55 CITV ZIP PNONE STATELICENSEI <br /> PWMBINOCONTRACTOR k�ILA00RE5S CIIY ZIP PHONE STI1TElICENSE� <br /> CONTA�CT PRICE OF WOFK <br /> HEATING SYSTEM: ❑GAS J ELECTRIC ❑ <br /> DESCR��KMI�ryUAR�TA�INVO{M�, 0 /�� /%�� N , CONTRCTPENSONANDPNONENO. <br /> { T�7J ��� ✓ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PNpqSED ��,�/cauuoirx3 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �TT CJ2 �'� WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIN OR <br /> LEOALDESCRIPTIONOFPROPE (SHOWNBELOWORATfACHTYOCWIES) NUL THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot e�ocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO�I OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFIUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICP.'1014 I� MADE ANO I COMPLY WITH THE STATE <br /> PARCEL TiVf 1 O.NUMBeR CONTRACTQRS WW 1827 RCW AND 29620 WAC. <br /> i <br /> CONSiRUCiION LOAN l ENDER.A�DRE55.TELEPNONE NUMBER x (����G� I L/��� <br /> SIONATURE D�TE <br /> CITY BUSINESS LICENSE N0. <br /> PLUMSINO MECHANICAL <br /> N0. TYPE OF Fl)(TURE OH ITEM FEE N0. TYPE OF FlXTURE OA ITEM FEE <br /> WATER CLOSET(TOILE� � PJC—AMNDL(3 UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> LAVATORY(WASH BASIN) i HEAT PUMP � <br /> SNOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYEHS i <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRV TRAY ; RANGE HOOD i <br /> CLCTHES WASHEF i WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREFLACE �_ <br /> SINK(SERVICE—BAR,ETC.) � GAS RAN6E ' <br /> ' GAS PIPINO ' <br /> i EXHAUST FAN � <br /> i ' <br /> i ' <br /> � ' <br /> � ' <br /> SUB TOTAL E ' SUB TOTAL S ' ' <br /> � ' <br /> PERMIT $ i PERiv11T S � <br /> TOTAL FEE 5 ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAP SETOACK SIDE SETB�CK PLAN CII�C�� P/ �/05 3v AEGEI����� <br /> CJ T <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> I ❑YES � � BUILDING �� �O <br /> HEIGHi LIMITAT�ON NO OF DWElUN6 SIZE OF ULDCiR.I. � <br /> UNITS iAn/L /.{� p�UM81NG � <br /> 7�-ri .�r <br /> pp�UPPANCY NOOfStt%AES OCCUPANTIO�D BASEMENT_L���� MECN�NICRL , <br /> � �'VES ❑ NO � <br /> FlPEALARM E�O✓'0 REASON ) ADDIPONALPUNCHECK � <br /> �{J'J (��(/L/`,�V(..�i OiHER i <br /> FIRE SPRINKLER REO'D RERSON �� <br /> y_� A..�y�,/� /Ay /L7I'/II/I/I11d SiRTEBUILDIN�SURCHMGE � <br /> (� YF. � !/W [,fH4/vA7K�Z• <br /> TVPE OF CONST. PIANS AFPFOVED BY CITY OF EVERE7T PUBLIC WORKS � <br /> �� � � �M LOCALSALES � <br /> o�iE � TAX CODE IS 3105 TOTAL �i �� <br />