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AP�PLICA7I�,N FOR CONS'TRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98�01 •259-8810 <br /> ❑ DEMOLITION Cl COMBINATION lXBUILDING I� MECHANICAL f� PLUMBING rl SiGN <br /> PROJECTADDRESS n�// �. n <br /> d u-'C <br /> 01YNER MAILAD�RESS Citt 21P PHONE <br /> C'�Fr� A��LS��t 7�/ �'�.l�a�, E.�.-�r oZs v� --� >oT <br /> TENANT MNLFUORESS CI1Y 21P PHONE <br /> Sf�"/�'1 � <br /> ARCHRECTORUESIGNEA MAILAUORE55 CI1Y ZIP AHONE <br /> GENERALCONiRACTOR MAILAUDRESS CITY ZIP p8zs� PHONF STATELICENSE/ <br /> / <br /> N�r/ 'C�r-.-�c �iZ � � G'o� ThE LK ST✓�Y-�^� �.�5�-5Z6z No-.pr*,C -/avtv <br /> MECHANICTLCONTRACTOR MAILAODRE55 CITY ZIP PHONE STATEIICEN E� <br /> PLUMOING CONTRACTOR MAIL ADONE55 CITY ZIP PHONE STATE LICENSE� <br />, CON�RACi PRICE OF WOIiN <br /> X 6 G r HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCP E WORN ANO SOUARE FOOTAGE INVOLVE� CONIACT PERSON�ND PHONE NO. <br /> S F' �' s9�+'i�- �_ <br /> -� � 3 y - �ialaa- <br />, � ��.�� I HEREBY CERTIFY fHAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALL <br /> PROPOSED USE OF BUIL c PROVISIONS OF LAWS AND ORDINANCES GOVERNING'fHIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEQRLDESCRIPTIONOFPROPERTY�SHOWN9ELOWORATfACNTWOCOPIES) NOT. THE GRANTING OF A PERMI7 DOES NOT PRESUME TO GIVE <br /> �ot �`�'� z e�ocrc�oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> / - / OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />, S�k/ff-L eLL_ S z il C �P-e[d PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />( L .3 D `d O APPLICATION IS MADE AND I COMFLY WITH THE STATE <br /> PARCELiAX1.D.NUMBER CONTRACTORS LAW 18.27 RCW D 296.200 WAC. <br /> ,�,i/ — a�0 <br /> CONSTROCTION LOAN LENOER.PDUPESS.TEI.EPNONE NU�18ER x '�!(�� -� y-/7 -9 6 <br /> SIGNATURE UATE <br /> CITV BUSINESS UCENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � � <br /> URINAI ' WOOD STOVE ' <br /> ORINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE i <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> �PjJ EXHAUST FAN � <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S � SUB TOTAL 5 � <br /> PERMIT S � PERId1T S i ' <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE OPILY: <br /> FRO`!T SEiBACO RE�R SEIDACK SIDE SEiB� PLAN CHECK%UMOER � fC �. LJ� RECEIPT NO. <br /> Z f� � <br /> USEZONE ✓ LOTAREA VRCANTSITE FEES VALUATION FEE <br /> f7YES fl NO OUILDING / � — <br /> �C�NI I NOOFOWELIING SIZEOFBLDG?I. / i <br /> � /� UNITS 66o S,l', P�UN�ING i <br /> OCCUPONCY NO OFSI0RIE5 OCCUPANTLOqO BASEMENT MECNANICAL � <br /> GROIIP �� <br /> U_� 1 f1YE5 IMND � <br /> FIqEALARMRE00 REASON AUUITIONALPLANCHECK � <br /> i <br /> OTHER � <br /> FIRESPRINKLERREOD RE�SON <br /> � <br /> STATE OWIOM�SURCHARGE ��� <br /> TVPEOFCONST �'IANSAPPt30y�BY CITYOFEVERETT �UOLICWORKS ---�- <br /> .�J- � � LOCAL SALES <br /> �C. �� onTe q .3� 96 TAX CODE IS 3105 TOTAL � I� <br />