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� APPLICATI�.�1 FOR CONSTRUCti .ON �ERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br />� 3200 CEDAR STREET• EVERETT, WA 98201 •259-8610 <br /> ❑ DEMOUTION ❑ COMBINATION rl BUILDING � MECHANICAL ❑ PLUMBING fl SIGN <br /> PROJECT ADDRESS <br />' ONTlER MAILAOURE55 CITV ZIP PH <br />, 7�,�� / . ��.�w:� i � � ����,..�„_.i 39 Ol ,� ' <br /> TENANT MAILAOORESS rv�L�r �G��CIN ZIP pHONE <br /> ���L� /0 7.L i `�j`f �i s'�'if c.r /) l!�/J.1,�'7/ l��N ��.ddfr �J 7 S�Sfr <br /> i ARCHITECTOR�ESIGNER MRILADDP.ESS CITY 21P PMONE <br /> 1 <br /> GENERRLCONTRACTOR MAILAD�RE55 QTV ZIP PNONE STATELICENSEII <br /> MECXANIGILCONTRACTOR MAILAD�RE55 CITY ZIP PHONE STATELICENSE� <br /> ��Lrl .5�,¢v.�s L.< <f0.C.7 c �Qcec���.� �!/i..�17� //�/� Sj/v/ .>'64lY�S' M�GYSSL/e/✓i' <br /> PLUMBINa CONTRACTOR MAILADDRESS CIN ZIP PHONE STATE LICENSE� <br /> CONiPACT PPICE OF WORK <br /> ,3Sd� HEATING SYSTEM: j3�GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK ANO SQUARE FOOTAGE INVOLVEO CONTACT PERSON AND PHONE NO. <br /> —56�Q.e�n� .2 fic�r.�,c L,� ,�-� �!t .. <br /> �'f� v S � zd1.a �� E�S <br /> /'o.0 Q.t�LZvC a+�ZI-bS.if 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUIIDING 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 /> LEG�LDESCPIPT70NOFPROPERTV�SHOWNBELOWORATfACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTfiUCTION.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 /> PARCELTN(I.�.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRE55,TELEPHONE NUMBER /�p� ��cS �S <br /> �SI N IIRE A DATE � <br /> l/ <br /> CITV BUSINESS LICENSE NO. <br /> PLUMBIN6 ��� MECHANICAL <br /> NO. TYPE OF Fll(TURE OR ITEM FEE NO. TYPE OF PIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASII!) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOG � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOH DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUST FAN i <br /> i i <br /> � � <br /> � � <br /> - T <br /> � ' - I <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> PEfiMIT $ � PERMIT $ � � <br /> TOTALFEE $ � TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PIAN CNECK NUMBER FEE RECEIPT N0. <br /> USE ZONE LOTAREA VACANT SITE FEES VALUATION FEE <br /> ❑YES ❑ NO BUILDING � <br /> HEIGHTIJMITATION NO.OFDWEWNC SREOFBLOG?.I. � <br /> UNITS p�UMBING � <br /> �— <br /> OCCUPANCY NOAFSTORIES OCCUPANTIOAD BASEMENT � <br /> GROUP MECHANICAL i ; <br /> ❑VES f7 NO � . <br /> FIREAIARMREO'0 REASON ADOIilONr1LPLANCHECN i <br /> OTNER � <br /> : <br /> FIRE SPRINKLER REO'D REASON i <br /> STATE BUILOING SURGNPFGE i <br /> TVPE OF WNST PlANSAPPROVED BV CITY OF EVERETT PUB�IC WOFKS � ' <br /> LOCALSALES � <br /> OATE TAX CODE IS 3105 T07AL I <br />