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APPLICATIG.J FOR CONSTRUCT .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION Cl COMBINATION fl BUILDING I-7 MECHANICAL � PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> c�� � E � -'% l�� <br /> OWN R MNLAODBF.SS ` GIT" ZIP PHONE <br /> /l��//�gf ��v /o�� Pu� �yo� !��//�?oo/ 53 -03a51 <br /> TENANT MAILADORESS Cltt 21P PHONE � <br /> c3v.�� ea ��rs �9a5 �c-n_��c� !�RY ���� <br /> ARCHITFCTORDESIGNER MAILPDDRESS CIN ZIP PMONE <br /> GENER�LLONIRACTOR MAIIADDRESS CITV ZIP AHONE STATELICENSE� � <br /> MECHANICALCONTRACTOR MIIILADDRE55 CIN ZIP PIIONE STATELICENSE� <br /> PLUMBINGCONTRACTOR MAILAODRE55 CITV ZIP VHONE STATELICENSE� <br /> I�LI.-OLUlH3 NbJ S� I�i lyo"{ P� NE MFW�s��r.� c�R I��71 G53/4/� f�u/��.v�anyn� <br /> COIlTRACT PRICE OP WORK <br /> � )'>OU• �� �1EATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AN�SOUARe FOOT4GE INVCLVEb CONTACT PERSON ANO PHONE N0. <br /> �l�.]p�rJT 1�-ES�cz�vvt <br /> I HEFEBY CERTIFY THAT I HAVE READ AND EXAA7INED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEDUSEOFBUI�OING PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS 7YAE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED FIEFEIN OR <br /> LEGAI.DESCRIPTIONOFPflOPEHTY�SHOWNBELOWORATTACNTWOCOPIES) NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK_._._.OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofi ThIE <br /> PERF RMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWN OF THIS PROPERTY PERFORM THE WORK FOR WHICH <br /> APPI TION �5 ADE I COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMBER CONTR CTORS 1827 AND 296200 WAC. <br /> CONSrpUCT10N LOAN LENDEh.ADURESS,iELEPHONE Nl1MBER / I X/ -- <br /> 5!G DATE <br /> CITV BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> W.4TER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS�—B''.U. M E.A. ; _ <br /> LAVATOHY(WASH BASifJ) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK&DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN ' <br /> l�;UNDRY T'iAY ; RANGE HOOD � <br /> CLOTHES WASHER i WATER HEATFR � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> T <br /> FLOUR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> @ACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE ' <br /> � GAS PIPING � <br /> EXHAUST FAN � <br /> � ' <br /> T <br /> 1 <br /> 1 � <br /> 1 <br /> ' � 1 <br /> SUB TOTAL $ 2/ ' SUB TOTAL S '� i <br /> , � <br /> PERtviIT Q � i PERMIT S � <br /> TOTALFEE 5 � TOTALFEE 5 ' <br /> f <br /> � FOR OFFICE USE ONLY: <br /> FRONTSETOACK REARSETOACK SIDESETBACK PLANCHECKJ)U6�DER FEE RECEIPTNO. <br /> i <br /> Nw3�J <br /> USEZONE LOIAREA �ACANTSITE FEES VALUATION FEE <br /> i <br /> ❑VES ❑ NO OUILDING i <br /> HEIGHTLIMITATION NOOFDWELLING SIZEOFOLDGRI. � <br /> UNITS � <br /> PWMUING � <br /> �� <br /> I <br /> � OCCUPANCV NiiAFSTOFIES OCCUPAM LO>D BASEMF.NT <br /> MECHANICAL i <br /> GROUP <br /> � ❑YES O NO � <br /> � FIRE ALAFM REO'0 F7EA504 A�UITIONPL P'J.N CfIECN � <br /> �� <br /> i <br /> OTHER � <br /> I FIPE SPPINKLER REO'D REASON � <br /> STATE BWLDIN�SUIICHAAGE � <br /> i <br /> i <br /> NPEOFCONST. PIANSAPPFOVE00Y CiTYOFEVERETT P�BLICWORKS i <br /> LOCALSALES ; <br /> onre TAX CODE IS 3105 TOTAL ' <br />