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A►PPLICATIO.� FOR CONSTRUCTIJN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> O DEMOLITION fl COMBINATION fl BUILDING ly MECHANICAL f� PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> �5.25 Co�aY AvE. Ev����--r wr� q zo� <br /> ONMER MpIL11DDRE5S <br /> ��TM Z�� PNONE <br /> Q��L.T GR!]i )o �q�p ..s_t-nnro- A E k$qOS CVERcTT ni <br /> TENANT MAILADDpE55 ��n. <br /> ZIP i'NONE <br /> 11NCHI7ECTOpOESIGNEfl M�I(ADOqE55 ��ry Z�P <br /> PNONE <br /> GENERRICONTp�CTOR MAILlDORE55 LIiY <br /> ��� P110NE STATELICENSE� <br /> P��t-et'�.E�- itf� Sc EvFUT►�IV� 1 I�Y�'f #�01 tit'��cTwf� 9f?,'7DES <br /> MECHRNICAICONTRACTOR MAILADDRESS utt 21P <br /> PIIONE STA7ELICENSE� <br /> 0�4M0�� !-1F_�Hfll�iCr�t i�� �,rw �.�ri,�L.vNu�.�c»D 9R�1! ��u�a4i QLyMPMT�-�nPl <br /> PIUMB�NOCONTRI.CTOii MAILMDRESS CITV Zip <br /> PI/ONE STRTEUCENSE� <br /> C TRACTPPoCEOF\YORK � � <br /> HEATING SYSTEM: �-�GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AN�SOUARE FOOTACE INVOLVEO CONTRCT PERSON ANO�HONE N0. <br /> L <br /> � � � - = 3ERRy - <br /> - 2 4 - �l <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED USE OF BUILDIN APPLICATION AND KNOW THE SAME TO BE TRUE AND CORI7ECT.ALL <br /> F � — PqOVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TVPE OF <br /> LEGALDESCRIPT70NOFPqOPEPiY�SHOWNBELOWOqATipCHiWOCOPIES) �•�ORK WILL BE COMPLIED WIiH WHETHER SPEGFIED HEREIN OR <br /> �or B��K � o� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOFITY TO VIO_ATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OP,WCAI LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE UF CONSTqUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF TF1iS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M E AND I CO THE STATE <br /> rnqcE�r�x�.o.NUMaEa . CONTRAC�T/ORS LAW 1 7 g p A� <br /> CONSTqUCTION LORN LENDER,IIDORE55.TELEPNONE NUMBER / / ( �� /C7 <br /> x�p <br /> so. �N ruae O onrE <br /> CITV BUSINESS UCENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TVPE OF flXTUqE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOILET) FEE <br /> ' A/C-A/HNDLGUNITS-H.P. , <br /> BATHTUB ; FOqCED AIR SYSTEMS-�.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � <br /> ' UNITHEATERS-B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> OISHWASHER � VENTILATION FAN � <br /> LAUNDqYTqAY � ' <br /> � RANGEHOOD � <br /> CLOIHES WASHER � <br /> � WATER HEATER r- <br /> URINAL � WOOD STOVE , '— <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) ' <br /> FLOOR�RAIN � <br /> ' FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIPEPLACE � <br /> SINK(SERVICE-BAR,ETC.) ' <br /> � 6A5 RANGE � <br /> ' GAS PIPING <br /> � E%HAUSTFAN <br /> i ' <br /> � ' <br /> � i <br /> _. � � <br /> � <br /> SUBTOTAL E ; SUBTOTAL 5 L � <br /> PERMIT ' <br /> a ' PERMIT $ i, i <br /> TOTAL FEE $ � TOTAL FEE S ' � <br /> FOR OFFICE USE ONLY: • <br /> FAONTSETOACK REARSEtBACN SIDESETOACK PUNCNE KNUMBE(i <br /> fEE RECEmi NO. <br /> 1 �)"7� � <br /> usezot+e �oraqEa VACANi51TE FEES VALUATION FEE <br /> ❑YES ❑ NO OUILDINO T <br /> HEIOHT LIMITATION ��2 OF DWEIIJNQ 512E OF BLOG21. � <br /> u:J115 <br /> PLUMBIN� � <br /> �COUpANCY fq.OiSiD�IES OLCUPANiLORO BASEMENt ' <br /> MECII�NICAL <br /> ❑YES ❑ NO <br /> FIREALARMREQ'D REASON AOOIiIONRLPUNCHECK � <br /> FIRE SPRINKtER REO'O REASON OTHEB <br /> STATE OUIIDINO SURQIAqGE � <br /> TYPEOFCONST. PUNSAPPAOVED6Y <br /> � � C17Y OF EVERETT ruouc wonKs . � <br /> -M LOCAL SALES <br /> DAIE IG .�i gl TAX CODE IS 31Q5 TOiAI � <br />