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� <br />APPLICATIC..� FOR CONSTRUC7.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 258-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS �� D S � � //� �/� !N`'� <br />OWNEfl MPILPWNE55 � <br />1 ` <br />(rGu i "F �c <br />1ENANT MAILADORES� <br />ARCHITECTORDESIGNEfl MAILAD�RE55 CITV ZIP PHONE <br />GENERALCONTRACTCR MpILADDRE55 CITY 21P PHONE STATEUCENSEN <br />MECH NICAICONTflACTOR MAILADORpEcS CITY <br />�QSpGr�[�-�t4n�Ga � , 7�%3•'�S�l S`7� L�,n.�,� <br />PLUMBING ONTRAf.TOR MA!LAODRE55 T Cltt <br />C`l RZV �O�R� <br />� <br />DE RIBE WORK ANO SOUARE F007AGE INVOLVEO <br />�.,t�/ NJ�9C <br />PROPOSED USE OF BUILDINO <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW OR A7TACH TWO GOPIES) <br />LOT BLOCK OF <br />PARCE.LTA%I.D.NUMBER <br />CONP'•'�IUCTION LOAN LEN�ER. PDDRE55. TELEFHONE NUMBER <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />URINAL <br />FOUNTAIN <br />FLOOR DRhIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />FOR OFFICE USE CNLY: <br />FRONTSETBACK REAR! <br />USE ZONE <br />HEIGHT LIMIT.�TION <br />OCGUFANCY NOAFST( <br />GFOUP <br />FIRE AtARM REO'D <br />FIRE SPRINNLER REO'D <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />IOTARF.A <br />PIO. OF DWELLJNG <br />UNITS <br />OCCUPANTLOAO <br />REASON <br />REASON <br />P WNS APPROVED BY <br />PHONE <br />�f� G�z-�� <br />PHONE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACi PEHSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERNIIT DOES NOT PRESUME TO GIVE <br />AUTHORITv TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OP THE <br />PFRFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO LAW 1027 RCW AND 296200 WAC. <br />x � � ��t S/�&r 'T�' �(7 ' ( ) _ <br />SIGNAT OATE <br />CIN BUSINESS LICENSE NO. <br />MECHANICAL . <br />FEE NO. TYPE OF FIXTURE OR ITEM <br />� � A/C —A/HNDLG UNITS — H.P. <br />� FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />� UNIT H�ATERS — B.T.U. M <br />� CLOTHES DRYERS <br />� VENTILATION FAN <br />; P.ANGE HOOD <br />� WATER HEATER <br />SIOE SETBACK <br />VACANTSRE <br />❑YES Ci NO <br />SIZE Or gL�G�T�. <br />METAL <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />SUB TOTAL b <br />PERMIT $ <br />TOTAIFEE $ <br />PLAN ClIECK NUM _ I FEE I RECEIPT N0. <br />�va s <br />Bl11LDING <br />PLUMBING <br />�SEMENT IAECHANICAL <br />❑YES (' M1O <br />AO�ITIONAI PLAN CHECK <br />OTI{ER <br />STATE BUILOING SURCHARGE <br />CITY OF EVEREiT PUBLIC WOPKS <br />LOCAL SALES <br />TAX CODE IS 3105 707AL <br />