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APPLICATII..�I FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 32C0 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBI�IATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> .�� o `� G E'Cr,—. C��.e_ �v.��. z� C%�i� <br /> OWNEq , MMLADDRE55 � CITY ZIP PNONE <br /> �F F L <br /> Gtoxiir r/F+ �/dro/+i� inzo Nc: v,�-K//Zl�L/�ND 9�033 �S'2S�- G�/5' <br /> TENANT MAIIADDRE55 CITV 21P PHONE <br /> ARCNITECTOHDESIGNER MRILADDRESS CI7Y IIP PNONE <br /> � <br /> �ENE LCONTRAC70R MAILAOORE55 CITV ZIP PHONE STATELICENSE� <br /> //�N'�✓ <br /> MECNANICALCONTRACTOR MAILADDRESS CITV ZIP PIIONE STATELICENSE+ <br /> PLUMBING CONTRACiOR MRILADDRE55 qiY ZIP PHONE STATE LICENSE� <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE FOOT�GE INVOWED CONTACT PEHSON FND PHONE NO. <br /> .t�f, fJ. i7't..[.G�� /LUZ <br /> �'�`v 'C�n�, o—t�c�r , <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDIN� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LE6�LDESCRI ONOFPROPERiY15MOWNBELOW rr�cHnvo OPIES) NO7. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> �or e�ocK cF 9 6�+�tt �� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> � 5 �C�2 PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ceLTA%I.D.KUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � 5'7a o a C�vo3 {/� /J / <br /> CONSTRUCiIONLOANLENDER.A0DRE5S.TELEPHONENUMBEP �(1�"k�. �'(.��«�(���'� �O- .�O- `/� <br /> 5 �ATURE DATE <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF fl)(TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � AIC—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UN�THEATERS—B.T.U. M ' <br /> KITCHEN SINK&DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION rAN ' <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WUOD STOVE ' <br /> DR�NKING FOUNTAIN � METAL FIREPLACE(VJOOD BURNING) � <br /> FLOOR DRAIN � FIREPI.ACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � OAS RANGE ' <br /> GAS PIPING ' <br /> i EXHAUSTFAN � <br /> i ' <br /> i ' <br /> � ' <br /> � ' <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> PERMIT $ i PERMIT $ � <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETOACK SI�E SETBACN PUN CIIECN NUMBER FEE RECEIPT NO. <br /> 5 ia <br /> USEZONE LOTAflER VACANTSITE FEES VALUATION FEE <br /> i i <br /> ❑YES ❑ NO BUILDING � � i � <br /> HEIGHT LIMITATION NO.OF DWELLING SIZE OF BLDG/CI. � <br /> i <br /> UN1T5 p�UM01NG � <br /> OCWP�NCY NO.OFSi0RIE5 OCCUPANTLOAD BRSEMENT MECMANICAL i <br /> GROUP <br /> ❑YES ❑ NO r j <br /> FIREAIARMREO'D REASON ADDIT10NAlPLANCHECK � � <br /> i <br /> � <br /> OTIIER i <br /> FIRE SPPINKLER RFO'D PEASON � <br /> SiATE BUIL�ING SURCHARGE � CJ <br /> TVPEOFCONST. PIANSAPPA VEDBY CITYOFEVERETT �UDLICWORKS i <br /> �'}� LOCAL SALES <br /> DATE I'• TAX CODE IS 3105 TOTAL � - <br />