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APPLICATIOI�� FOR CONSTRUCTI.. N PERMI'4' <br /> CITY OF EVERETf• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS Z / <br /> ,��, - _ r���� c���� �L�c Cc����' �.Cih- ct <br /> OWN� M�ILAODRESS 7 1 21P ^l10NE <br /> f�/+21��U/U � ��SS 0��. �U. a u I(��� �t/in.�u�c,� �iJt�, 2 dL••-Lo"L�9- �f S 3 �� <br /> TENANT MAIL�OORESS CITV 2P PHONE <br /> , ��rs�r'�j��'���. �v rc aec u rv�_ <br /> ARLHITECT ROESIG ER MAILAD RESS CI 21P PHONE <br /> w�5 �. �,�,���W�. z���� �,�,a���. ,!�I�>���;� w�,, ,y�s�y z��E, •15'3 - 7.07D <br /> GEN A.s�ONTRACTOR 1AAILAOCFlES r� '(J � � Q� ZIP PyONE 3 STATELICENSEI �„ <br /> �I , Kcl�erzL���n � . . � p�z �r���/�� ��t• � 3/1l� r3s � JR03EKC3�`ff'IE �:� <br /> MELHANICALCONTRACTOfi MRILADORESS CITV 21P PHONE STATELILENSEN r <br /> E <br /> PLUMBINGCONTRACTOR MAILADDRE55 Cltt 21P PNONE STATELICENSE� <br /> CONTBACTP ICEOFWOPK <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK JD SOUA FOOTAGE I^VOLVED CONTACT�RSON AND PNONE 'O/ <br /> (ih/ S�/LGi �U:. � ?�/ �LI 1 OVt' ' 1� l O �P2^ �4�NL� �' <br /> . .G .' J f��.t � /}/U• ����.s" �y L 3^ 5' �?] <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PRBPB9EBtl5EOF BUILUINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVIS�ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> L��FF/� �' WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAIUESCRIPTIONO�PROPERTV�SHOWNBELOY/ORATfACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT BLOCN aF AUTHORITY TO VIOLATE OR CANCEL THG PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTqUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> PnqCEL Tnx I.D.NUMBER CO�RAC RS L 18.27 ' GJ AND 296200 WAC. <br /> / / <br /> CONSTRUCTIONLOANLENOER.ADORESS.TELEPHONENUMBER x • � ✓ -✓ � 'L <br /> SIG TUf1E DATE <br /> CITV B1151NE55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> N0. TYPE QF FI%TURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DI:.P i CLOTHES DRYERS i <br /> DISHWASHER i VENTILATION FAN � <br /> LAUNDRYTRAY � RANGEHOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR ORAIN � FIREPLACE INSERT(WOOD 9URNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUST FAN i <br /> i � <br /> SUB TOTAL S ; SUB TOTAI S ; <br /> PERMIT $ i � PERMIT S i <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: �� � <br /> FRONf SETBACK REAR SF.TUACN SIDE SETBACI( PLAN HECK NUM�Efl, FEE �� ZiECEIPT N0. <br /> Z <br /> usezo��e �o7nRen vacnNrsiie FEES VALUATION FEE <br /> ❑YES n No ,�'r,2! _ <br /> BUILDINO � <br /> HEIGNTLIMITATION NO.OFOWELUN6 SIZEOFBLOGR.I. � <br /> UNITS I�n �/,.1AI/� PLUMBING � <br /> /w cT»s.�iri <br /> GRC��UjPnANCY NO.OF510NE5 OCCUPANTLOAD BASEMENT MECHANICAL � <br /> �3` t No Gl•l�Nl� f]YES C7 NO � <br /> ADDITIONAI PLAN CHECK i <br /> FIFEALARMI7E0'0 REASON - � <br /> N� OTHER � <br /> FIRE SPqINKLER REO'0 REASON i <br /> � STATE 9UIL➢ING SURCHARGE �� <br /> T/PEOFCONST. PLANSAPPROVEDBV CITYOFEVERETT �rueucwoaKs � <br /> � t�M LOCAL SALES — � <br /> DA7E q /7 ,` TAX CODE IS 3105 TOTAL � �`J � <br />