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pppLICATIO.� FOR CONSTRUCTI JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOUTION [� COMBINATION ❑ BUILDING ❑ MECHANICAL � PWMBING Cl SIGN <br /> PROJECT ADDRESS <br /> �in, Zi� PI/ONE �j V/ <br /> OYRJEP MAIL AOURE55 L,,, 2 S t -46 7 t 7/ Z- 7 n�� <br /> N�I�'Y M� H Y' 3 0o En NE `r' E LFa',-� `18 <br /> cin, Z1P i�HONE <br /> TENPNT MAILAUDRESS <br /> ���, Z�p PMONE <br /> ARCHITECTORDESIGNER MPILAD�RE55 � <br /> � � � ���, Z�p PHONE STATELICENSE/ <br /> GENERALCONTPACTOR MPILR00(iESS �' � .L� Y.�J N,�,�y��,y z3oo� <br /> Nq�a�ti, � r� 2�3L �FN +-�t*�v .4 : r'o�:��l--t `ix <br /> MECHANICALCONTRACTOR MAILAD�PESS <br /> CIN ZIP PNONE STATE LICENSE� <br /> ��n, Z�p PHONE STATE LICENSE• <br /> PLUMBINGCONTRRCTOR MAILADDRE55 C/� n�� 1 -�� .� `• P GI <br /> P� • �, � 3vi� r� o�,: <br /> CONTRACTPRICE OF WONN /Z ���� , HEATING SYSTEM: ❑GAS jKT ELECTRIC ❑ <br /> CONTACT PERSON AND PHOIN^E NO. <br /> DESCRIBEWOHKANDSOUAREFOO'iAGEINVOLVE� ^t �9� LA �! � �`� � 7-51 rJ ySV <br /> ,. � ivr . �l� P <br /> ►�7' { �CifC fh�<< <^'�R� FE •�fRf <br /> I HEPEBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAP4E TO BE TRUE AND CORRECT.ALL <br /> PROPOSEO USEOF BUIIDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> tr s�p���, WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGPLOESCRIPTIONOFPROPERT'�ISHOWNBELOWORwT����!��r�7 AUTHO TY TOTVIOLATEAOR CANCELETHE PROVISIQN OF ANY <br /> ipT 1 y L BLOCK ��oF OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �J�V�,��r� N PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> qpPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> PARCELTA%I.D N MBER _ � �D/ � <br /> � �� - ��-�� <br /> CONSTRUCTION LOAN IENDER.ADDRESS.��EPMONE NUMBER SIC TURE . OATE <br /> f � 259- � <br /> CITY BUSINESS LICENSE NO. <br /> PLUMBING MECHANICAL FEE <br /> TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTUHE OR ITEM <br /> NO. � q�C—q/HNDLG UNITS—H.P. ' <br /> � � WATER CLOSET(TOILET) _ , FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> BATHTUB ' ' <br /> — , HEAT PUMP � <br /> LAVATORY(WASH B�:IN) _ � UNIT HEATERS—B.T.U. M <br /> � <br /> SHOWER � CLOTHES�RYERS ' <br /> ( KITCHEN SINK&DISP ' ' <br /> � VENTILATION FAN � <br /> DISHWASHER � � RANGE HOOD ' <br /> LAUNDRY TRAY � WATER HEATER � <br /> ( CLOTHES WASHER � � <br /> i WOOD STOVE , <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTA�N ' ' <br /> � FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN i GAS FIREPLACE ' <br /> BF,CKFLOW PREVENTEFS ' ' <br /> , GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) , GAS PIPING <br /> ; EXHAUST FAN � <br /> i i <br /> � � <br /> � <br /> SUB TOTAL 5 i <br /> SUB TOTAL S � � PERMIT S ' <br /> PERMIT S ' TOTAL FEE S ' <br /> TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: FEE RECEIPTNO. <br /> FRONTSETBRCN <br /> REAR SETOACK SIDE SET9ACK PIAN CHECK NUMOER . <br /> FEES VALUATION FEE <br /> USEZONE LOTAREA VACANTS�IE ? .� � <br /> ❑VES ❑ NO ppILDING J 000 � � <br /> ��i <br /> HEIGNTUMITATION NOOFDWELLJNG SIZrEOFBLIX'iRl. pLUMBING <br /> UtlITS NX�51��' /� ; <br /> OCCUPANCY NO.OFSTONIES OCCUPRNTLOAD BASEMENT NECHANICAL <br /> GROUP . ' <br /> ❑VES fl NO � <br /> A pDDIPONAI PLAN CHECK � <br /> FlREALARMHEO'0 REASON i <br /> OTHER � <br /> i � <br /> FIRE SPRINKIER FEO'D REASON STATE BIIILDING SURCHARGE <br /> NPEOFCONST PLANSAPPROV DBV CITY OF EVERETT P�OLICH'ORKS � <br /> J LOCAL SALES �2. D <br /> � -/.I DATE iJ TAX CODE IS 3105 TO7AL <br />