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APPLICATI� FOR CONSTRUC'�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �,.PLUMBING ❑ SIGN <br /> P OJE TADDRES • �OIZ� ��(J�9( �1L� <br /> . <br /> u'/in � � E55 1 cm ZIP PHONE <br /> TE T / ES /�— / QTY 21V PI 01 NE �J`J� �(.�j�— <br /> w K+ <br /> �RCNITECTO{iDE51GNER MA �ODRESS �Itt ZIP PHONE <br /> `�'!�� `�-�.�.�.,, �,µ.�. ao�-7�] -317 7 <br /> GENEPAI CONTPACTOR M�IUODRF.55 CITY pIP PIIONE SUTE UCENSE� <br /> MECNANIC�LCONTFACTOR M�IIADORE55 CITY ZIP PIIONE ST�TEIICENSE� ' <br /> ��G-»� •o035 <br /> PLU IM CONTR�CTqi M�IL ADOHESS CI7Y 21P PHONE $TATE LICENSC/ <br /> zecl�a,��-4-c.��,�c. � � .z- o�' P. o . ���wa.. B.T/+IE eer��9Bnr <br /> CONT CTPRICEOFWORK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCRIBE YAMK ANO SOUARE FOOTAGE INVWVED CONTM;T FENSON M!D PMONE NO <br /> � I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> P p ��� 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 COMPLIEO WITH WHEiHER SPECIFIED HEREIN OR <br /> IfG�LDESCRIPTIONOFPROPEflTY�51qWNBELOWORATfhCHTYqCOPIES) NOT. THE �RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF /lNY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR YVHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PMICELTA%I.D.M/MBER CON TORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTiIUCTION LONI IENDER.ADD1iE55.TELEPHONE NUMBER X �i�j(�/ /` r <br /> SIGNATURE l.TE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OH ITEM FEE O. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—A/HNDLG UNfTS � <br /> BATHTUB ; FORCED AIR SYSTEMS ' <br /> � <br /> UWATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 3 DISP � CLOTHES DRYERS ; <br /> DISHWASHER � RANGE HOOD � <br /> kAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> UflIMAL � MEfALFIREPLACE�W00DBURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPV+CE � <br /> BACKFLOW PREVENTERS ; GASRANGE ' <br /> SINK(SERVICE—BAR.ETC.) GAS PIPING � <br /> IXHAUST FAN <br /> � � <br /> i <br /> � � <br /> � i <br /> � � <br /> � n � <br /> SUB TOTAL S � �/ SUB TOTAL S ; � <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE S � 70TAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRpNT SETBACK REAR SETB�CN SIDE SETBACN P�AN CHECN NUMBER FEF RECEIPT NO <br /> u5E20NE IOT�REA veCu+rSrtE FEES VALUATION FEE <br /> _ ❑YES 0 NO BUILDING � <br /> NEIGNT UMITATION NO OF DWELUNG SIZE OF BLDGRI � <br /> UNI7S PLIJMBING i <br /> _ i <br /> GC�COPANCY fq Of$IOPoES OCCUPANfIO�D BASEMENT � <br /> MECNaNILnL � <br /> ❑YES ❑ NO ' <br /> FIRESPflINKLERflEO'D AE�SON pDDIIIONRLPLRNCIIF.CN <br /> i <br /> OTHER <br /> iIflEAWIMflEO'0 REASON � <br /> $TATE B111L�ING SIIRCIIMGE ' <br /> i <br /> TYPEOF(;ONST PL�NS�PCIiOVEUOY CITYOFEVERETT �IIBIIf,WOPNS <br /> LOCALSALES --�— <br /> onre TAX CODE IS 3105 7oTAL j <br />