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,� -, <br /> APPLICATIVA FOR CONSTRUCTrON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-9810 <br /> C7 DEMOLITION fl COMBINATION jkl" BUILDING fR'MECHANICAL PLUMBING fl SIGN <br /> PROJECT ADDRESS /�� ��V.� �� <br /> ONMER M�ILADDRESS CITV ZIP PMONE <br /> �f�r, I�e-2� I�5� 7 3"�'�"' .t�lit= 3C�,�r-�- -�/�d o� 3 3 7-o/ h'S- �,�c.n <br /> TENAM M�I MORESS CITY 21d PHONE <br /> ARCHIiECTOR0E51GNER MAII��ORE55 CITY 21P PHONE <br /> GE�GONTR�C� Mp4ADDRE55 Citt ZIP PNONE STATELICENSEIr <br /> �' ��ed c..�s�- S� <br /> MECNANICRLCONTRACTOR MAILADDRE55 CITV ZI7 PHONE STATELICENSE• <br /> —7'B�6 C .�l�? ca-j <br /> PLUMBINGCONTRRCTOR MAILADDRE55 CITY ZIP PHONE STATELICENSE� <br /> CONTfUCT PAICE OF VIORK /�� <br /> HEATING SYSTEM: GAS rl ELECTRIC f�l <br /> SCRIBE WORK ANO$WARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> ,�! ' �4 I��✓' Q'L�C7G� <br /> '7� <br /> I HEREBV CERTIFV THAT I HAVE REA� AND E%AMINED THIS <br /> APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> rnOroSeo u5E oF euaDrtrc PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF r <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �cuoescmvnoaoFrRorearrlsNowr+ee�ow N c iesl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior�_e�oac o� /� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONLTriUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PF:OPERTY TO PEHFORM THE WORK FOR WHICH - <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTN(I.D.NUMBF.R CONTRACTORS LAW 1N27 RCW AND 286200 WAC. <br /> CONSRIUC710N LOIW LENOER.AODRESS.TELEPHONE NUMBER /� U � / �/ <br /> SIGN��' ATE <br /> pTV BUSiNE55 LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> TYPE OF Fl%TURE OR ITEM FEE N0. TVPE OF EWIPMENT FEE <br /> • WATERCLOSET(TOILE� / � A/C—AIHNDLGUNRS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP � � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> UIUNDRY TRAY i RAN6E H000 i <br /> CLOTHES WASHER — � WATER HFATER ' <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACF(WOOD BURNING) i <br /> . FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ! <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � 6AS RANGE ' <br /> � X GAS PIPING // � <br /> i 3 EXHAUST FAN � <br /> � ' <br /> � ; <br /> i <br /> � ' <br /> SUB TOTAL $ ' SUB TOTAL $ i <br /> i <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACK / RE�R SETBACK SI�E SETB�CK PUN CHECK NUMBEP FEE AECHPT NO. <br /> 2� �� . 5� J.����� ��/ � <br /> use zoNe LOT AREA V�CANT SITE FEES VALUATION FEE <br /> _ �.—I � ( 3� r�s r; No euaniNc q �73�0 ��� <br /> HEIGNT IIMITATION� NO.OF U ELUNG SRE OF BLDG/fl � <br /> 7Q UNIT$ � j(p SF t/�IR��,} pLUMBING � <br /> (.Q <br /> OCWPANCY NO O�SIORIES OCCUPANTLO�D BRSEMENT MECHANICAL i <br /> GRWV — <br /> 3 ., I (� IIYES � 0 � <br /> FIRE URM REOD PFASON ADDIiIONAL PI.AN CHFCK � <br /> i <br /> OTNER i <br /> FIRF.SPPINKLER REO'0 FF.ASON � <br /> STATE BUIl01NC SUPCHARGE �� <br /> TVPEOFf,ONST PLANSAPPRO�(E�Y CITYOFEVERETT ���BLIC,WORKS 20� <br /> J LOCAL SALES -+ <br /> �-/J onTE -4-q to TAX CODE IS 3105 TOTAL � � Q <br />