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� <br /> APPLICATIt►A FOR CONSTRUCT�t�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f� DEMOLITION fl COMBINATION rl BUILDING �MECHANICAL rl PLUMBING fl SIGN <br /> PROJECT ADDRESS � � I q <br /> � � �O12L. <br /> ON?!ER MRIlA00RE55 CITY ZIP PNONE <br /> TEN/�� � MAILIIO RES�� CITY����I IIP �� E�FH�� � ��l�_ 3CQ�. <br /> ,�ll \�4-'� <br /> �RCHRF.CTORUESIGNER MAILADDFE55 QTV 21P PHONE <br /> G NE LGO TRACTOf7 �AIUODRESS CIiV 7.IP P110NG �SiATEUCENSE� <br /> — �$�� 7�a"��on IVO�THin► FI1o3121 <br /> MECNA ICALCONTRACTO MAILADDRE55 CIN 21P PIIONE STATEUCEtSSEr <br /> PLUMBINGCONiRACTOR� ` MAILAODRESS CIN ZIP PHONE STATELICENSE� <br /> CONTMCT PRICE OF WOR � <br /> � HEATING SYSTEM: GAS I-1 ELECTRIC I� <br /> DESCRIBE M/ORN PNO SOURRE FOOTA E INVOLVED CONTACT PERSON ANp PHONE NO. � �� <br /> r <br /> . �1��`'1 AIl �J�'111}�.�i4`� 5 �. �� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED USE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPl1ED WITH WHETHER SPECIFIED liEREIN OR <br /> LEGIILDESCRIPTIONOFPROPERTY�SHOWNBE�OWO�iRTTACH7WOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT� BLOCN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REG TIN ' NSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRU N. A THORIZED BV THE <br /> OWNER OF THIS PROPE TO P' M THE ORK FOR WHICH <br /> APPLICATION IS M A PLY ITH THE STATE <br /> CONTRACTORSLAW 27 2962 W C. <br /> PMCELTNfI.D.NUMBER � � O U � ZI � <br /> CONSTRUCTION LOM!LENDfR.ADDPE55.TELEPHONE NUMBEN ?( " / �� <br /> :IGNAiURE DATE <br /> CIiV BUSINESS LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR I7EM FEE NO. TYPE OF EQUIPMENT FEE <br /> T <br /> WATERCLOSET(TOILEn � ' A/C—A/HNDLGUNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T. M E.A. ' <br /> i <br /> LAVATORY(WASH Bi.31N) � HEAT PUMP ' <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY ; RANGE HOO:) � <br /> CLOTHES WASHER i WATER HEATER ' <br /> URINAL WOOD STOVE � <br /> i <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 RANGE ' <br /> � GAS PIPING <br /> � <br /> � EXHAUSTfAN � <br /> i <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ '� <br /> TOTALFEE S ' TOTALFEE $ ` ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETPACN REAR SETBRCN SIDE SETBACK PLAN CIIEGN NUMBER FEE RECEIPT NO. <br /> usezorve IOTAREA V�CANiSITE FEES VALUATION FEE <br /> nves r No am�nir+c I <br /> NEIGMTIIMITATION AOOFOWELLING FIZEOFBLDGRI � <br /> UNIfS p�11MBING � <br /> i <br /> OCCUPANCY NO Oi SIONIES OCCl1PANT LORD BASEMENT MECMRNICAL � <br /> GROUP � <br /> fIVES Il NO � <br /> Ap01110NPL['LAN G�F.CK � <br /> FIREALPRMREO'D RF.ASON <br /> � <br /> OTNER <br /> FIRE SPR�NKLER REO'D REA<pN � <br /> STAIE 9111LOING SURGMARGE <br /> TYPE Of f,ONST PlANSPPPROVEO BV CITY OF EVERETT ��IpUf,WORKS i _ <br /> LOCAL SALES ; <br /> DATE TAX CODE IS 3105 70TAL ' <br />