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� <br /> �'��'`� APPLICATIC�1 FOR CONSTRUC�ON PERMIT <br /> � j�j CITY OF EVERETT•BUILDING DIVISION � <br /> 320U CEDAR STREET• EVERETT, WA 982U1 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL fl PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> /o9Z9 /��.�o.,v l� f/wy 99 Gv�,etrr wA yBzo.¢ <br /> OWNER MAILAODRESS CITY IIP PMONE <br /> l�.eoc,r �.ose�,+ /0 92 9 6/wy 99 Ev�rr 982o f S/3-Z/GS <br /> rE/ 1U�Ib � G ��J�–Cl�.o�s cm ziP PMONE fJGBU�CI053DB <br /> � y L4'�' !- !� nnwo 03 7 <br /> ARCHI CTORDESICaNER MAILAODRESS qTV IIP PHONE OQ� � <br /> .1t�+��-�r—fi�e , <br /> �^ENERALCONTRACTOR MAILADORE55 T CITY 21P PHON ATELICENSE� <br /> C <br /> MECN IC CONTRACT�, MAIUD�R�SS CITV ZIP PHONE � STATE LICENSE� � <br /> /� <br /> � � - <br /> �r�,� .� G� ��:�:-- �i?-� �F iio�� ` ��. � ���« �i6a �� <br /> PLUMBING CpryTqqp7p�p MAI�A�DPE��� CIN ZIP PHONE STATE LIGENSE� <br />� CONTRACT PRICE OF WORK <br /> ,�0� Odd HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> � DESCRIBEWOPKANDSOUAREFOOTAGEINVOIVED CON TPER NAN�PHONENO. 'C �as-a <br />��" . O iT/o o �ri� N< ST.everva � - <br />�, �'�D�CoX C�D S f!' A�To- (�E-%HEkE 5/3 —Z/GS DE.v.v� <br /> li� '� � I HEREBY CERTIFY THAT I HAVE REA� AND EXAMINED THIS <br />� � � ,, PROPOuED USE CF BUILDINO APPUCATION AND KNOW THE SAME TO BE TRUE AND CORpECT.ALL <br /> NE� CA.t .QEQ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />� � �'' WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> ` LEOALDESCRIPTIONOF ROPERTY�SHOWNBELOWOR�TGCHTWOCOPIES) NOT. THE GRANTIN6 OF A PERMIT OOES NOT PRESUME TO OIVE <br /> sp�� ' , � . '� �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � '�` � '` OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> ' '� t PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br />� �� <br />� ��I ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � `" :� APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> � PMCE TA%I.O.NUMBER CONT CTORS 18. p W AND 296200 WAC. <br />� � 4Z9�0o/-O/Z -O/ <br />�`;J,�� : - � �e+ CONSTRIICTONLOANLENDER,ADORESS,TE�EPHONENl1MBER x — � '� <br /> ' 'f ATURE � lJ 6 � D�TE� ��'^� .• <br /> i � 7 ii <br /> � CITV BUSINE55 LICENSE NO. <br /> -- ' .' .;��.Y: ._ . <br /> . PWMBIN6 MECHANICAL <br /> .:��._ �. �� NO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF Fl7(TURE OR REM FEE �C�.�^ <br />' . � WATER CLOSET(TOII.En � A/C—NFiNDLG UNITS—H.P. � �` <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. � ' .:.��r <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNITHEATERS—B.T.U. M � ��;�', <br /> KITCHEN SINK&DISP ; CLOTHES DRYERS ' '� <br /> i <br /> DISHWASHER � VENTILATION FAN � ' . <br /> LAUNORYTRAY ; RANGEHOOD ; „�,�:� <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL ' WOOD STOVE ' a <br /> ORINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) i �,�..! <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � � -1 <br /> BACKFLOW PREVENTERS � GAS FIREPLACE ; ;.,di1 <br /> SINK(SERVICE—BAR,ETC.) � GASRANGE � �.,,1 <br /> ' GAS PIPIN6 ' �� <br /> — � EXHAUST PAN i — .,-� <br /> � <br /> � <br /> i i <br /> i i <br /> � � . <br /> � i ,; <br /> SUB TOTAL S � SUB TOTAL $ � - <br /> PERMIT $ i PERMIT $ i � <br /> TOTALPEE $ � TOTALFEE S � � <br /> FOR OFFICE USE ONLY: aO J F <br /> FRONTSEfBACK j� � REFHSETBA�O / SIOESETBR�� / PIANCHECNNUMBER` F�� � RECEI�%%�/� � '�'�6. <br /> / / �f � ✓ <br /> CO d � <br /> USE ZONE ` / LOT AREA VACANT SITE FEES VALUATION FEE <br /> nves n No BUILDING �j�p�'ZO p ' SC� <br /> HEIGHT LIMITATION NO.Of DWELLING SRE OF BLDGRI. � <br /> UNITS / PLUMBING i <br /> OCCUPANCY NOAFSTOHIES OCCUPANTLORO BAS'MENT MECHANICAI i <br /> GROUP � <br /> .}n7 ❑VES �0 � <br /> FlREMARMHEO'0 REASON A�UITIONRLPLANCHECK i <br /> N? � <br /> OTHER � <br /> FIRE SPRINKLER PEO'D REASON � <br /> i <br /> �u SfATE BUILDING SURCHARGE �/ <br /> TVPE OF CONSi. PLANS A POVED BY CITY OF EVERETT PUBLIC WOHKS � j <br /> 1 , LOCAL SALES � � <br /> V –� unte � 2�. S TAX CODE IS 3105 TOTAL (p(� I G}/ <br />