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� <br /> APPLICATION FOR CONSTRUCTIt�N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION f-I COMBINATION fl BUILDING fl MECHANICAI r� pLUM81�?G �1 SIGN <br /> PROJECT ADDRESS /�� �� <br /> OWNER M�ILADDRE55 CITY 21P PHONE <br /> r 1 ih.�,'�e �3.L� �O /a 5'� i ��O '�'',9vL � , z �cf� 9�ac� �oG 33 �- 7S3�o <br /> TENANT MAIL�ODRE55 CIiY ZIP PHONE <br /> ARCHRECTORDESIGNEN MRII�DDRE55 CITY :IP PHONE <br /> �-�G2r55�'�v� �Jes,G� <br /> GENERAL CONTiiACTOR MRIL r1DDRESS CIiY 21P PHONE SiAiE LICENSE� <br /> Dc�►a-�� ��=Q� �.nst �sn ��6.3a�9B9y� .��n� M g aa vo� <br /> MECHANIC�LCON7qA�TOR NRILADDRE:iS CITV 21P P/IONE SiqTELICENSE� <br /> .S/c�2?,�� /kk�f;;� .ri <br /> PLUMBINGCONTRACTOR MAI E55 CIN ZIP PHONE SiATE'.ICENSE� <br /> h� P/� ;� <br /> CONTPoICT pRICE OF WORN <br /> HEATING SVSTEM: �.AS fIELECTRIC fl <br /> DE RIBE VIORK AND 5 ARE FOOTAGE INVOWE� � CONiRCT PERSON PND PHONE NO. <br /> �C ��i�� U <br /> �2 c/�� . <br /> 2 � I HEREBY CERTIFY THAT I HAl'E READ AND EXAMINED THIS <br /> reoPoseo use oc em�arac APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7.ALL . <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ec��oesc�+^^• �NORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � .7NOFPROPERr1�N'NBELOW ACHTWpCO esl NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior�__e�xK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH <br /> APPL�CATION IS MADE AND I COMPLY W�TH THE STATE <br /> wace�r�yc�i.�aea CONTRA'RS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUVCTION IO�N LENDER,ADO(IE55.TELEPHONE NUMBER '"�X ���7 �� �� ���y� <br /> SIGN� E E •V <br /> . D�TE <br /> . CITY BUSYNESS UCENSE NO. <br /> PLUMBINa MECHANICAL <br /> NO. TYPE OF FlIITURE OR ITEM FEE NO. TYPE OF EpUIPMENT FEE <br /> WATER CLOSET(TOILE� � A/C—AIHNDLO UNfTS—H.P. —T— <br /> � BATHTUB ' / FORCED AIR SYSTEMS—B.T.U. M F.A. ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP -�— <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS ; <br /> , DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANGE HOOD ' <br /> CLOTHES WASHER � WATER HEATER —T <br /> URINAL � � WOOD 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 HANGE <br /> ' GAS PIPING ' <br /> i EXHAUST FAN i � <br /> � � <br /> i � <br /> - � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL $ � <br /> PERMIT $ � PERMIT $ <br /> TO7ALFEE E ' TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FPONT SFiBACR RERH SETOACK SIUE SETBALK Pl4N CNF.CN NUMBEP FEE �) _./) RECEIPT NO. <br /> Z� � V �ia, <br /> — <br /> usezor+e IOTRREA VRC�NISITE FEES VALUATION FEE n <br /> _ � 1Sp ryve� r; rvo ew�oiNr, � Q3 1 �7C� <br /> HEIGMTUMITATION NOOfOWELLING 52EOFBlDG I <br /> �w UNIfS � � 74:,�F ��/`C�f- PLIIMBING /� � � <br /> 4(l r / � <br /> T <br /> OCCUPANCV NO O�S10FIES OCCUPANT LORD BASEMENT MECNnNICAL O �p� <br /> GROU � <br /> � U� / f1VE5 I�JO <br /> FIPE�URM REO'D RF.ASON A�OIIIONAL PLpN CHECK <br /> OTHEq � <br /> i <br /> FIRF.SPRiNKIER REO'D RE�SON <br /> i <br /> STAIE BUILDING SUfiCHMGE i/Y� <br /> i,�i <br /> TVPE OF f,ONST PL�NS RPPROVE BY CITY OF EVERETT �'��Bl lf,WORKS � <br /> / \.J�` LOCAL SALES � ' �� <br /> �`� �pTE Gy TAX CODE IS 3105 TOTAL � i � <br />