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APPLICATII N FOR CONSTRUC► ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION fl BUILDING �_1 MECHANICAL PLUMBING f-1 51GN <br /> PROJECT ADDRESS <br /> PS�1S �`Dti.BY �4ve • ) e �'�.�E%( , cg.20� <br /> OWNEi� MAIL�DDRGSS qTY IiP PHONE <br /> ,S n,-ri� n� �3c�[ �,� �uc,e�-rr 5�'a�6-sa�� <br /> TENANi MAILADDRE55 CITV zlP PI/ONE <br /> ANCIII7ECTOROESIGNE� M41L�DURESS Gltt zIP FNONE <br /> Gi:NERALCONTB�CiGR MAILADURE55 CI(V ZIP PHONE ST�TEUCENSe� <br /> ��L'� �culsT. /� N�� �?v�..ss "3Ec�v�it ��3 5/s'i= <br /> MECIfANICALCONTRALTOA MAILADDRE55 CIN ZIP FNONE STATEUCENSE� <br /> PWMBItiGfONTRACTOR MAILADURE55 CIiY ZIP fHONE ST�TEIICEN5E1 <br /> �: nw�,�,�� �az�� � s�r�,� H ��90 ���-��� f+k75P1-/z38D <br /> CONTRRCT PPICE OF WOFN <br /> 3� �L2,G� / HEATING SYSTEM: ❑GAS fl ELECTRIC ❑ <br /> DESCRIBE VIORK AND SOURRE FOOTAfE INVOLVED �,p CONTRCi PERSON AND PMONE NO. <br /> � ) .. � <br /> C � �� <br /> 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BIIIUNNG APPLICATIQN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDiNANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCF:PTIONOFPROPENTY�SHONMBEIOWOR.OTfALNiWOCOPIES) NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> trn _etocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN(3 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THlCf I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCELTA%I.D.NUMBER CONTRA,C/TORS lAW 1Q,27 RCW AND 296200 WAC. <br /> CONSiPUCTION LOAN lENOEP.ADDRESS,TELEPHONE NUMBER yr+(/J�/n[C /f XJ(3%�.a�Ft . ���S/Y�F <br /> � _���/.?i J3� o�re <br /> CITY BUSINE55 LICENSE F0. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF Fll(TURE OR ITEM FEE NO. TYPE OF FlXTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � AIC—A/HNDLGUNITS—H.P. � <br /> BATNTUB ; FORCED AIR SYSTEMS--B.LU. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHON'FR � UNIT HEATERS—B.T.U. M ' <br /> KITCM�N SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANOE HOOD ; <br /> —r <br /> CLOTHES WASHER � WATER HEATER � <br /> I�RINAL WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLA(:E(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENiERS ; GA.S FIREPLACE � <br /> SINK(SERVICE—BAR.ETC.) GAS RANGE � <br /> ' GA'J PIPING ' <br /> � EXHAUST FAN � <br /> i � <br /> SUB TOTAL $ ;i SUB �O?AL $ ; <br /> PERMIT S � .� PERkIIT $ � <br /> � <br /> TOT�L FEE 3 � � TOTAL.PEE 5 � ; _ <br /> FOR OFFICE USE ONLY: <br /> FfiONi SETBACN RE�R 5[TBACN SIOE SETBRCK PIAN CIIECH NUNOER PEE REC[IPT N0. <br /> y/r 3/ � <br /> USEZONE LOTAREA \'ACAM�SIiE FEES VALUATION FEE <br /> f]Y[5 CI NO g�pLDING <br /> i <br /> HEIGMTLIMIT�TION NOOFOWELLING SIZEOFBLDG/f.l. � <br /> UNITS PLUMOING � <br /> OCCUPANCV NO Of STORiES OCCUPANT LOAU BASEMENT MECIIANICAI j <br /> GROUP <br /> ❑YES ❑ NO ' � <br /> FIREALARMREO'D PGSON ADDIPONAI.PUNCNECr' � <br /> � <br /> OTIIER � <br /> FlRE SPRINKLER REO'D REASD4 � <br /> STATE AUILDINQ Sl1NC11nHUE � <br /> �—T—� <br /> TVPE OF CGNST PLANS APPROVEO BV CITY OF EVERETT PUBLIC WOFNS ; - <br /> LOCAL SALES � — <br /> oATE TAX CODE IS 3105 TOTAL ' _ <br />