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APPLICATIOrI FOfi CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL f I PLUMBING f 1 SIGN <br /> PROJECT ADDRESS ��C <br /> .J /'1 Oi� ' <br /> OWN5/R MAI�qDDIfiE55 Cltt ZIP PIIONE <br /> —I/��A�(.7��i ���7/y� l <br /> IENANT � 1AMLAUORE55 f.RY ZIP FNONE � <br /> ARCHRFCTORDESIGNER MAILAO�RESS CITY IIP PNONE <br /> GENEMLCONTR4C70R MRIL�DDRE55 CIIY 71P PHON[ STATELICENSE• <br /> MECH�NIC�L CONTRACT MAIt ADDRE55 Cltt PIIONE STqTE LILENSE� <br /> � -tfi �I b,,.., � Z�� <br /> �-�w�t �� <br /> t 5 <br /> PLUMOINGCON7RACTOR MAIL�D 55 CIiY Z�p pHONE STATELICENSE• <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: I I GAS �l ELECTRIC f� <br /> DESCRIQE WORK AND SOUARE FOOTAGE INVOIVE� CON7FCT PERSON AND PNONE NO. <br /> i _..� <br /> ' � <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PPOI'GSEDUSE OF BUILDING 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 OF <br /> IECALDESCI..'TIONOFPROPERTY�SHOWNBELOWORATTACHTWOCOPIES) NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or OLOCN 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 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND i COMPLY K'ITH THE STATE <br /> PaRCELTAXID.IJUMBER CONTRACTORS LAW 18.27 FCW AND 296.200 WAC. <br /> CONSTRVCTION IOAN LENDER.ADORESS,TELEPIIONE NUMBER ��� ��— �1 � q�� <br /> S ATURE / ( — <br /> OATE ^7 <br /> CItY BUSINESS UCENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I7EM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—lVHNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAV ; RANGEHOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL ' WCOD STOVE � <br /> DRINKING FOUNTAIN METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE , <br /> � ��" ' GAS PIPING � <br /> � EXHAUSTFAN ' <br /> � � <br /> i , <br /> SUB TOTAL S .�; SUB TOTAL S � <br /> PERMIT 5 /� i PERMIT 5 � <br /> TOTALFEE 5 "� TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> fRONTSF.T[iACN REAq$FTOACN SIDESETBACe i'lANl11ECKNUMOER 'EE R[CEIPTNO <br /> usezor+e ioraaen VACANf517E FEES VALUATION FEE <br /> nves i� no our.ninc ' <br /> HEIGIITLIMITATION NOOFDWELLING SIZEOFBLDGRI <br /> I <br /> UN115 i <br /> PlI1M01HG � <br /> i <br /> OCCUPANCY NO Ot5I0RiE5 OCCUPANTLOnD BnSEMENT � <br /> GPOUP MECIIAN'CAL <br /> fIVES Il NO � <br /> i <br /> FIRE ALARM REOD RFASOY ADDI110An1 PLAN CIIFCK � <br /> OiNER <br /> FIRESPPINKIERRF.O'� RFASON <br /> i <br /> STAIE BNIDING SURCN4RGE <br /> trveoFr,oHsr rtnvsnrvr+oveoov CITYOFEVERETT rue�.ir,wonKs <br /> LOCAL SALES —�— <br /> oarE TAX CODE IS 3105 TOTAL � <br />