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APPLICATI�,N FOR CONSTRUC'� iON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION Cl COMBINATION �" BUILDING ❑ MECHANICAL CI PLUMBING fl SIGN <br /> PROJECT ADDRESS ���� E�E,p�,y,e6Eit/ l.vAY - �uTN Ei`/� �F'B�'B <br /> C1ry Z�� PHONE a <br /> OWNER MAILADDRESS �A� �x � L C''G ♦ ..��1 01079/f ���STSO <br /> �,I�•Zf� �/.�./iiA c� C�� �.sr� /.39D0 rJ Jc cal <br /> 1ENRNT MAILADDRES_ <br /> GITv ZIP PNONE <br /> AP.GHITECTORDESIGNER MPILPUDRESS <br /> CIT' ZIP PMONE <br /> 21e PNONE STATE LICENSE t <br /> MAILADURESS GITY <br /> GENERALCONTRpC70R G 'C� �rJiKSQ �.'7 57� �pQ6�� ��b�N� <br /> -/�./ ,� A_LuY�H !�: �{.. _SIZO�� STATEUCENSE� <br /> v L�4//� �39�• - ? qTY 21P PIIONE <br /> r MECH�NIC�LCO".TRACTOR MRILADDRESS <br /> ZIP PHONE STATE UCENSE/ <br /> PLUMBING CONTPpCTO E55 ��ry <br /> � <br /> cor+ a�c ICEOF RK HEATING SYSTEM: ❑ GAS ❑ELECTRIC ❑ <br /> GONTACTPERSONANOPHO NO. <br /> pESCRIBE WORK AND SWPRE�A��Nr LVEX�,j <br /> LfC� is <br /> j. <br /> �� L <br /> L <br /> �y�� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI <br /> S � /� �$ CK S/ E qppLICATiON AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> pqpPOSED USE OF B111�DING PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WOHK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPiIONOFPROPEHiY�SHOWNBELOWORATTACNTWOCOPIES) AUTHORITYTOTVIOLATEAORRCANCEETHE PROVSSON OF A1NY <br /> �oT BLOCK oF OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> Q PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> qpPLECA�IONHI SP MADET AND PERCOMPLY EWIT�H KTHE STATE <br /> CONT CTORS lAW 1827 RCW AND 296200 WAC. � <br /> p/�RCELiA%I.D.NUMBER Qf.L OD /O <br /> � <br /> CONSTRUCTON IOAN LENDER.�DDi1ESS,TELEPMONE NUMBER S G OATE . <br /> � <br /> CITY BUSINESS LICENSE NO. <br /> MECHANICAL FEE <br /> pLUMBIN6 FEE Np, TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF Fl%TURE OR ITEM q��_q/�{NDLG UNITS—H.P. � <br /> WATER CLOSET(TOILET) � FORCED AIR SYSTEMS—B.T.U. M E.P.. � <br /> BATHTUB � � <br /> , HEAT PUMP � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> � <br /> SHOWER , � <br /> � CLOTHES DPYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> i <br /> DISHWASHER RANGE HOOD � <br /> � <br /> LAUNDRYTRAY ' � <br /> , �VATER HEATER � <br /> CLOTHES WASHER , WOOD STOVE <br /> � <br /> URINAL � � <br /> � METAL FIREPLACE(WOOD BURNING) <br /> DRINXING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) <br /> � <br /> FLOOR DRAIN GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GAS RANGE <br /> � � <br /> SINK(SERVICE—BAR,E'fC? � GAS PIPING <br /> i <br /> � EXHAUSTFAN � <br /> i � <br /> i <br /> � � <br /> � <br /> SUB TOTAL S � <br /> SUBTOTAL $ i pERMiT $ ' <br /> PERMIT S ' TOTAL FEE 5 � <br /> TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: FEE FECEIPTNO. <br /> REAR SETBACK SIDE SETBACK PIA��CNECK NUMBER . <br /> FRONT SET9ACK 7 p p I <br /> FEES VALUATION FEE <br /> LOTAREA VRCANTSITE �,/ iO� <br /> USEZONE f7VE5 n NO gUILDING `/'n a' <br /> _ � <br /> HEIGHTLIMITATION NOOF�WELLING SIZEOF0LWR1. ��M�S�,�/(� p�UM91NG 1 <br /> uNirs /.�opJ �..�q�i cN•T � <br /> OCCUPANCV NOAFSTORIES OCCUPANTLOA� BASEMENT / MECHANILAL ; <br /> G�UP� I NA ❑YES � NO � <br /> fs p�01TI0NAl PLAN CHECK � <br /> REASON � <br /> FIRE AURM REO'D �' i <br /> ��5 /L LSrG OTHER i� <br /> i <br /> FIRE SPRINNLER PEO'D REASON STATE BUILOING SURCHAFGE � <br /> V� 5 r�c�tC,. � — <br /> TVPEOFCONSL P�NSAP �EDDY GITYOFEVERETT PUBLICYlJFKS __ . � <br /> ' / � LOCAL SALES � <br /> V_ �y oATE - � 3 - y TAX CODE IS 3105 TOTAL <br />