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APPLICATIO�FOR CONSTRUCTIuN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBIN/A/TION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: �d"/3 �V�tiRt-ti /�� st�' 3 <br /> OMmEH MN�ADORESS � Citt Zm' p��pr+E <br /> rl'I6'/�iA�3 3ao �U�' �-e y�G G_�c� S�Oo� � �c3 -o��.sl <br /> TENANT uRRA00RE55 QTY ]in V��ONE <br /> �RCHITEGT OR Oe51GNER M�IL AOORESS Cltt 71P PIIONE <br /> GENERAICONTMGTOfi MNLApOf1E55 CItY —� 71I` PHONG $f4TELICENSE� <br /> MEC�ICeAeON�T^OeR �If��DqES����/ Cltt 71P PIIONE STATEUCENSE� <br /> // y�, <br /> ' PWMBINGCONTH�CIOR M�ILA�DRE55 CIiY ZIP PIIONE $TATELICENSE� <br /> CONTR�GT PHICE OF WORN <br /> FiEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCR19E WOHK�ND SOUARE FOOTAGE INVOLVED CONiACT PC1150N ANfI PNONE NO <br /> ti — � �va <br /> I HEREDY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> PiiOPO5EDU5E OF BUILDING APP�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLL , <br /> PROV�SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LUESCRIPTIONOFPROPERtt�SHOWNBELOWOflATf�CHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �or e�ocrc oF AUTIiORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEq STATE OR LOCAL LAW RECaULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br /> � APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> . PARLEILV(I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRULTION LOUJ LENOER,AODRESS.TELEP110NE NUMOEli X <br /> SIONAIURE DATE <br /> CItt OUSINE55 UCENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—MiNDLG UNfTS � <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> — , <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY THAY ; WATER HEATER ; <br /> CLOTHES WASHER � W00�STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKINC FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> ' EXIiAUST FAN ' <br /> � <br /> � � <br /> � � <br /> � � <br /> _ ' <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL 3 ; <br /> PERMIT 5 � PERMIT S i - <br /> TOTALFEE E ' TOTALFEE S ' <br /> FUR OFFICE USE ONLY: <br /> FRONT SETBACN FEAR SETBALN SIOE SETBACK PIAN CIIGCINIIMff��� FEF �ECEIPT NO <br /> ya� <br /> uSEZOnE tot�nEn v�CnN75itE (EES VALUATION FEE <br /> ❑YES ❑ No ow�niNr � <br /> HEIGHT IIMITATION NO OF DWELI�NG SIZE OF OLDGR.1 � <br /> UNIIS PLUMOIN6 i <br /> � <br /> OCCUPANLY NO OFSIOwFS OLCUPANfLOAD BASEMENT MECIInNIf.At � <br /> GROUP � <br /> ❑YES ❑NO - <br /> FIRESPFINKLEflREO'D AEASON ��OI71�NA1.1`IANCIIf.LN � <br /> i <br /> omen L (�� r9fl <br /> FIPEAIARMREO'D AE/SQN <br /> i <br /> S7n1E OU�I�iu65i1flpinfiGE i <br /> TYPEOFf,pNST PlANSAPPpOVEDOY CITY OF EVERETT runnr.won�s � � <br /> LOCAL SALES — -�— <br /> oATE TAX CODE IS 3105 7o7A1 (' � �� <br />