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--. <br /> APPLICATI6A FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERFT'T• BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-6810 <br /> C7 DEMOLISION yd'COMBINATION 1�YBUILDING �1'MECHANICAL PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> �� �res� <br /> OMMER MNIAUpRE55.�,,y�r ��7y Z�IP PHONE <br /> �ENAq� II���MR�DRE55��" '� x ti�CITY` i 1O/{O� 3Q E Q�5/S� �� � <br /> 11RCHRECT OR DESIGNER MAIL ADORE55 LITY ZIP PHONE <br /> GENEPRLCONTRACTCA MAI��D�RE55 CIiY ZIP P110NE ST4TELICENSE/ <br /> 1 �`C6 s.�- T �Q C ! cM <br /> MECH�NIC�LCONTRACTO{i M�ILADDRE55 CIT1' ZIP PHONE STAT��ICENSE� <br /> PLUMBINGCONTRACTOR MAILADDRE55 CIN ZIP pHOYE STAIELICENSE� <br /> CONTRACT PRICE OF VIOfIK /� <br /> //a'-/d'CJ HEATING SYSTEM: GAS fl ELECTR!C I-1 <br /> OESCPoBE NOqK AND SOUARE FOOT�GE INVOLVED CONTACT PER59N�NO PNONE NO. <br /> �(!(/ <br /> I HEHEBY CERTIFY THAT I�HAVE READ AN� E7CAMINED THIS <br /> PilOPOSED USE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUF.AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEf3AL0E5CRIPTIONOFpROPERTY�SHOWNBELOW ATT�CHTNOCOPIES) NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wi��_BLOCK oF _ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINQ CONSTRUCTION OR THE <br /> PERFORMA�CE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWIJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PNiCELTiVf I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> . CONSTNUCTION LOAN LENOER,ADDRE�S,TELEPHONE NUMBER �l/�__ /�,�-9� <br /> "1{� / <br /> SIGN�TURE D�TE <br /> qiV BU51NE55 UCENSE NO. <br /> P����� MECHANICAL � <br /> NO. TYPE OF FlXTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � /VC—AIHNOLOUNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � Ti — <br /> SHOWER � UNITHEATERS—B.T.U. �M ' <br /> KITCHEN SINK&DISP � � C�OTHES DRVERS — ' <br /> � <br /> DISHWASHER � VENTIUITION FAN � <br /> LAUNDRY TRAV ' ; RANdE HOOD � ' <br /> CLOTHES WASHER i � WATER HEATER — � <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPUCE � ; <br /> SINK(SERVICE—BAR,ETC.) pAS RANGE � <br /> ' GAS PIPIN6 ' <br /> i EXHAUST FAN � � <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S � � <br /> PERMIT E � PERMIT $ � <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETB�CK PUN CHECK NUMBER FEE RECEIPT NO. <br /> Zo zo' 5J .��Q�l� �. �C3 <br /> usezor� LOTAREA we�Nrsrte FEES VALUATION FEE <br /> '�—� '� 30 �N1€S f i NO BUILDING 7 I-� � O i � <br /> HEI6HT LIMIT�TI�� NO OF DWELLING SIZE OF BLDGRI � <br /> 2 UNIiS / �� S Sf GaRa4� + P«�MBING � <br /> OCCUPANCY NO OFSfOFIES OCCUPANTLO�D BAS'UENT � <br /> i � <br /> GRWP �O M NI ' <br /> 3 J•� `L N q nves <br /> FIRE AUNM REO'[1 REq50N A�DIiIONAL PLAN GHF.CK � <br /> OTHEfl � <br /> � <br /> FIRE SPPoNKLER REO'D REASpN � <br /> STATE AUILDING SURCNARGE ISO <br /> TYPEOFf,ONST PlnNSpCPRC/V�BY CITYOFEVERETT �UBIICWORKS � <br /> J LOCAL SALES �, <br /> —/.� onTE I —�'—`1G� TAX CODE IS 3105 707AL I <br />