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' /"�, <br />APPLICATII..�1 FOR CONSTRUCI,.ON PEFtMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COh181NATION P� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />/(, <S . Gf/• EU�7P� 7T ff-LG <br />OWNE� , n M�LPDDPE55 GITY I ZIP PHONE Sv � <br />n <br />T <br />ADDRESS <br />P110NE— !/�'�a�" •dd � <br />D <br />SAti C t�t�7tl /C, l�[.¢ii7i� I�vMdNA� �I 176� 9D3- d�9o98g <br />�GENPALCONTRACJOR MAILAD�RE55 CITV 7.I PHONE STATEIIf.ENSE/ /Q�Z�G°/ <br />_� (nfsSi�GL.snms �� /!/� f'»drrfiu�' f�i• �e �er��/C9703y 3os�G���s3 <br />MECHANICALCONTHACTOR MAILAUDRESS CITY 21P �PH NE STAIELICENSE� <br />PLUMBING CONiRACTOR MFILADORESS CIN ZIP PNONE STATE UCENSE N <br />DESCRIBE WOPKANO SOUARE FOOTAIiE INVOLVED <br />LOT BIOCN <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AND PHONE NV. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />7WNBELOWORARACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOF_S NOT PRESUME TO GIVE <br />__ oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LGCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CUNSTRUCTION. THAT I AM AUTHORIZED BY THE <br />O R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />A LICATION IS MADE AND I COMPLV WITH THE STATE <br />CO RACTORS LptA17Qk'p'�JZW AND 296.200 WAC. <br />PARCELTA%I.D.NUMBER <br />COM1STRUCTONLOANLENDER,ADDRESS.TELEPHONENUMBER <br />i PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATH7"UB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR, ETCJ <br />SUBTOTAL S <br />F'ERMIT $ <br />TOTAIFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN AEARSE�6ACN <br />USEZONE LOTAREA <br />HEIGHTLIMITATION UNITSFDWELLING <br />OCCUPANCV NO.OiSTOFIES OGCUPANTLOAO <br />FIRE <br />3 <br />MECHANICAL <br />FEE NO. TYPE OF FIXTURE OR �TEM <br />� A/C—A/HNDLGUNITS—H.P. <br />; FORCEDAIRSYSTEMS—B.T.U. I <br />� HEAT PUMP <br />� UNIT HEATERS — B.T.U. M <br />i CLOTHES DRYERS <br />� VENTILATION FAN <br />; RANGE HOOD <br />� WATER HEATER <br />� WOODSTOVE <br />i METAL FIREPLACE (WOOD BURNIN� <br />� FIREPLACE INSERT (WOOD BURNIP <br />; GAS FIREPLACE <br />� GASRANGE <br />� GAS PIPING <br />� EXHAUSTFAN <br />SIOE SETBACK <br />VACANT SITE <br />VE f] NO <br />PLAN <br />� 5 ' BUILDING <br />SIZE OF BLDG/LI. <br />lvQ (�EUfLIf�/L PLUMOING <br />- i.+- -v r <br />SEMENT MECMANICNL <br />�YES ❑ NO <br />ACDITIONAL PLAN CNECK <br />OTHE(i `C <br />7 <br />STATE OUILDING SURGHAAGE <br />CITY OF EVERETT rueuc woares <br />LOCAL SALES <br />� TAX CODE IS 3105 7oTAL <br />FEE <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE $ <br />� RECEIPTNO. <br />S � �2.: <br />FEE <br />