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pPPLICATIG_� FOR CONSTRUCT �N PERMIT <br /> CITY OF EVERETf• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 • 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS � -�� �� � ����—c��/,-- <br /> OWNER N:AILADORE55 GN � ZIP ,PHON�� ,1�' -d32 .` <br /> �� -� ) �� Q 1�.�� � <br /> � / � 'V}��r�� CIN 21P PHONE <br /> TEN T MAIIAD�RE55 � <br /> � - � — 9. —� Ca <br /> ��n, �p PHONE <br /> ITECT OR D SIGNER MAIL. RESS <br /> ��n, Z�p PHONE STATELICENSE� <br /> G:NERALCOhTRACTOR MAILAODRESS <br /> . ��ry Z�p PHOtl a0� rje�H'/ TELICENSE� <br /> MECHANICAICONTRACTOR MAILAODRESS "' Q� <br /> 7L _ L � � rZ�P C�M~ pHONE STATELICENSEI <br /> ' MAILADDRESS CIN <br /> - . PLUMBING C NTRACTOP <br /> CONTFACTPRICEOFWORK HEATING SYSTEM: ❑ GAS ❑ELECTRIC O <br /> �� � CONTACT PEFSON PND PHONE N0. l�� <br /> �ESCRIBE WOHK ANO SOUAFE FOOTAGE INVOLVED f ` f � d U <br /> �''.`J-� / , <br /> � I HEREBY CERTIFY THAT I HAVE REA� AND EXAMINED THIS <br /> - APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEDUSE OF OUILOING PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGPLDESCPIPTIONOFPHOPERTYISHOWNBELOWORATTACfITWOCOPIES) AUTHORITY TOTVIOLA EAORPCANCELETHE PROVISION OF A'NY � <br /> �pT e�ocK � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �� � pEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WIiICH <br /> ApPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> PARCELTA%�.D.NUMBER` 23 3� � 3� �903 � / "I_� <br /> CONSTflUCTION LOAN LENDER.AUORE55,TELEPHONE NUM�EM`� �� `v SIGN flE DATE <br /> � <br /> CI BUSINE55 LICENSE NO. <br /> MECHANICAL FEE <br /> PLUMBING FEE NO. TYPE OF FI%TURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM � <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. <br /> � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> BATHTUB ' ' <br /> , HEAT PUMP <br /> LAVATORY(WASH BASIN) ' <br /> � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ' ' <br /> � VENTILATION FAN � <br /> DISHWASHER � RANGE HOGD ' <br /> LAUNbRY TfiAY ' ' <br /> CLOTHES WASHEF � WATER HEATER � <br /> � WOODSTOVE , <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ' ' <br /> � FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN i GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ' � <br /> , GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING <br /> � <br /> ' EXHAUST FAN � <br /> � � <br /> i i <br /> � <br /> � � <br /> � <br /> SUBTOTAL S i <br /> I SUB TOTAL S � pERMIT S ' <br /> PERMIT 5 ' TOTAL FEE 5 ' <br /> TOTALFEE S ' <br /> FG;9 OFFICE USE ONLY: aeceiaTNo. <br /> fFONT SETBACK � REAR SETBACK SIOE SETBACN PLAN CN@C NUMBE FE��� //�/�/ <br /> FEES VALUATION FEE <br /> V£'E ZONE LOTAREA VACANT SITE � <br /> ❑YES n NO BUIL�ING � <br /> � <br /> NO.OF OWELLING SIZE OF OL�GRI. � <br /> HEIGHT UMITATION � <br /> 11NIi5 PLUMDING <br /> i <br /> BASEMENT MECHANICAL � <br /> OCCUPANCY NO.OFSi0PIE5 OCGl1PANTlOAO i <br /> GROUP ❑YES ❑ NO � <br /> ADDITIONAI PLAN CHECK � <br /> fIREALARMREO'� PEASON / � <br /> OTHER � ' ! � <br /> � <br /> i <br /> FIRE SPRINKLER RE�'D HEA50 STA7E DUIL ING SURCHARGE � <br /> i <br /> TYPEOFCONST. P� �?ROVEOOY CITYOFEVERETT PUBLICWORKS � <br /> ��►• LOCALSALES I <br /> TAX CODE IS 3105 TOTAL <br /> DATE <br />