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ApPLICATIOr�I FOR CONSTRUC?�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION �I COMBINATION UILDING ,AAECHANICAL �UMBING fl SIGN <br /> PROJECT ADDRESS� — � <br /> ��T, Z�p PNONE <br /> � MRILADORESS � n � �/'� <br /> ,� ..0 v <br /> LITY 21P PNONE <br /> ANT p��A00 55 � <br /> ��ry ZIP PHONE <br /> RRCHIT T O E51 EP MPIL A/DDRE55 <br /> � /��j` CIiY 21P PIIONE STATE LICEN E� <br /> GF�IERpICONT CTOR MAILAOURE55 ��O <br /> —�3'.''� r.7 i JD �'ti/ l'/�l C� ls ����- <br /> �jSt,F,(� /��Riy ) / S / 7 GILy ciT, jiP PIIONE LICENSE� <br /> c HANICA CONTR OP MPILAODFESS <br /> PLUMBINGCONTRACTOR MpILADORE55 <br /> Cltt ZIP PHONE STATE UCENSE� <br /> CONTRACTPHICEOF WORK HEATING SYSTEM: I rl ELECTRIC fl <br /> OESCRIBE VJORN RND SOUARE FOOT�GE INVOLVE <br /> CONTA P RSONANO HONENO. <br /> A PL CAB ON ANDI KNOW THE SAME TO BE�T UE AND CORFlECT ALL <br /> p E s o ILDING PI�OVISIONS OF LAWS AND ORDINANCES GOVERPIING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDFSCRIPTIDNOFPROPERTY 'HOWNB LOWIXiA1TACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br /> �or.�._B��K � OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> pPPLECATOIONHI SP MADET AND PE COMPLYHEWITH KTHE STATE <br /> CON�TOR LA 2 RCW AND 296200 WAC. <br /> PMCE TR% .D.NUMBER ^ /� <br /> ����^ " �� <br /> COP�S��N IENDER.ADDPESS.TELEPHONE NUMBER GNRTURE UATE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBING MECHANICAL <br /> FEE NO. TYPE OP EOUIPMENT FEE <br /> NO. TYPE OF Fll(TURE OH ITEM , <br /> WATER CLOSET(TOILE� � e� A/C—AIHNDLG UNRS—H.P. <br /> � FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> BATHTUB ' <br /> G HEAT PUMP � <br /> `j LAVATORY(WASH BASIN) ' <br /> i UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP ' � <br /> DISHWASHER � VENTILATION FAN � <br /> � RANGE HOOD ' <br /> LAUNDRY TRAV ' � <br /> CIOTHES WASHER � WATER HEATER <br /> i WOOD STOVE <br /> p URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> O DRINKING FOUNTAIN ' ' . <br /> FLOOR DRAIN � IREPLACE INSERT(WOOD BURNING) <br /> � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS � � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING <br /> —� EXHAUST FAN � <br /> � � <br /> � , <br /> i ' <br /> i � <br /> SUB TOTAL $ ' SUB TOTAI $ � <br /> ' PERMIT 3 ' <br /> PERMIT S ' TOTAL FEE 5 � ' <br /> TOTAL FEE E ' <br /> �OR OFFICE USE ONLY: piA„u�ecKr+uMnFa PEF � RECFIPTNO. <br /> iRONT SETP�C� / AEAR SETBACK � SIDF.SETBACK J / �� �/� <br /> Z 5 FEES VAL ATION FEE <br /> USE20NE LOTAREA VRCANTSIiE '� ; , <br /> �'�'1 ��79g fyVES f 1 NO BUIIOMG S I <br /> HEIGNTLIMITPTION _ � �,N��DWELLING SIijOqFBL S�TJ L�v�NG t 2� <br /> �Ki LJ� $F AQ G� PLVMBING ,i'J �--" <br /> OCC4PPNCV NO OiS10RIES OCCUPANTLO�� BASEMENT •��//. MECNANILnI � /� -- <br /> f,ROUP � f1YE5 Y'�� <br /> •3 ,� I PODIIION�I.PL�NCMfiGN __ <br /> iIRE ALAi1M REOP RFASON ' <br /> Oi11ER � - <br /> i /� <br /> FIRESPRINKI.ERREO�� RE����� � ���-�" <br /> STAIE OUIIDILG SIIFCN4qG[ ti/_ <br /> r— <br /> TYPE OF CONST Pl�NS APPPQVEQ BV GTY OF EVERETT �'��Btif,WOPKS ___�[��.�___ <br /> J ry LOCAL SALES ' <br /> �� �AtE 2 tb/SS TAX CODE IS 3105 70TAL � - <br />