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� <br /> APPLICATION FOR CONSTRUCT JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION fl COMBINATION fl BUILDING f� MECHANICAL PLUMBING f-I 51GN <br /> �AOJECT ADDRESS <br /> Z ^. , <br /> OWNER MAILADDRESS Vv � ��� <br /> i QN 21P PNONG <br /> �1 A.'v )���m �c�^� , •�21� //)�'�'h�c-� ���1',� Q�/Y��� �"� <br /> TENANT MAILAf1DRE55 CITY ° � � <br /> �,� � l ZIP PHONE <br /> ��� =-f9z���u � ,.e-,� Q ,.� �'�az� <br /> ARCHITE ORUESIGNER Mq11qU0R SS ��n. <br /> Z��' PHONE 7 <br /> GENEpALCONTMCiOR MAILRO�RESS CIiY <br /> Z��' PIIONE STATE LICENSE� <br /> MECHANIL�LCONTRACTOR MAILACURESS ��ry <br /> Z��' PIIONE STATE UC[NSE� <br /> PLLIMBINGCONTRACiOP MAILAUORE55 CIN Zlp PHONE STATEUCENSE• <br /> _'7� ��9t-y�, `p�P ; ' I�H�n Ef10-�-�. Co�/3- s�o L <br /> CONTRpCT PPICE OF WORK '"- <br /> HEATING SYSTEM: Cl GAS fl ELECTRIC I-1 <br /> DE CRIBE WORK ANA SOU�RE FOOTAGE INVOLVED CONTACT PERSON AIlD PHONE N0. <br /> _ � <br /> U-« Wl. 'f cwv <br /> I HEREBY CERTIFV THAT I HAVE REA� AND EXAMINED THIS <br /> PROPOSED USE OF OUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPqOPERTY�SHOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIPJ OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> ��T eL�K --or' AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF COM1STRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATIDN IS MADE AYD I COMPLY WITH THE STATE <br /> PARCEL TA%I.U.NIIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> 4loz000a _0000 �� �l -._ /- <br /> CONSTqUCT10N LOAN LEN�Eq,A�ORESS,TELEPHONE NUMBER X �L /��/p/�� <br /> SIGNATURE ,7 <br /> Ai <br /> � � CITY BUSINE55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> , ND. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> � BATHTUB ; FORCEDAIRSYSTEMS—B,T.U. M E.f,. � <br /> . LAVATORY(WASH BASIN) —�-- <br /> i HEAT PUMP � <br /> � SHOWER � UN�THEATERS—B.T.U. M � <br /> KITCHEN SINK&DISP i CLOTHES DRYERS <br /> DISHWqSHER ' <br /> ' VENTILATION FAN <br /> � LAUNDRYTRAY � �_ <br /> � AANGEHOOD � <br /> CLOTHES WASHER � WATER HEATER <br /> URINAL ' WOOD STOVE � <br /> DRINKINCa FOUNTAIN ; METAL FIREPLACE(WOOD BURVING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WDOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> ; GAS PIPING <br /> � EXHAUSTFAN � ' <br /> � <br /> i <br /> � <br /> SUB TOTAL S � SUB TOTAL S � <br /> PERMIT S Z(J� PERMIT 5 �— ' <br /> TOTAL FEE $ �3 '�— TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN REAR SF.TBRCN SIDE SETOACN PL�N CIIECK NUMOER FEE FEGEIPi N0. <br /> USEZONE LOTAREA VFCAN7517E FEES VALUATION PEE <br /> _ f1VE$ fiNO OIIILDING � <br /> i <br /> HEIGII7LIMITAiION �IOOFOWELLING SIZEOFBLDG?I � <br /> UNIfS <br /> PLUMOING � <br /> OCCUPANCY NO 0[S10NE5 OCCUPANiLOAD BASEIAENT I <br /> GPOUP MECNnNICAI � <br /> flYES fl NO � <br /> FIRE ALARM REO'0 RFASON A�OIIIONAI.CLAN CHf.CK i <br /> � <br /> OTHER � <br /> FIRESPPINKLERREO'D REn50N � <br /> STAIE DUIIDING SURCH4qGE <br /> TVPEOFf,ONSi PUNSAPPPOVEOAY CITYOFEVERETT �IIHIlf,W0iiK5 <br /> LOCALSALES — _�_ <br /> ome TAX CODE IS 3105 TOTAL I <br />