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APPLICATII.N FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVEREI � • BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION _.Ff'�UILDING �1 MECHANICAL �i''T"PLUMBING fl SIGN <br /> PROJFCT ADDRESS �/ / <br /> ���=� "7 .P�tf1..2-1�''� �e'�_-� <br /> OWNF dAILAD/9_f�ESS l �(^/ {�} CITV 21P PN NE <br /> '�p�� �rJ'/C JQ� / / �C_.Y "'i � :' '--� r•'i'. <br /> 9.l ���/ F1 '�rP `'�'i< c� �/,— _. <br /> TENAN MMLAO�RES$ Q ZIP PNONE <br /> � <br /> ApCjIRECTORI/E5IGNER NAILA DRE55 Cltt � � T.IP PMONE ) <br /> � ..� _ J �rt�. 5 .�) /lr �Z /7�; --�,• G,:.) ��.r•,...�:� c�/ 7`�Z —�7�h <br /> GEN�ALCOHRPCTOR� � MAILA DRE55 � CITY ZIP � f➢{0 � /r� � NSE� <br /> 9 /' l+��� �/�. <br /> i ; - "—�.l- v., zS�-1 F,;�r-.7`.� v�.��_ '' AP/?�'-9EC��J'1)l <br /> � /('a�-�.. L ' vi �'< <br /> MECNANICALC NTR4CTOR MAIIA�DRE55 � CITY ZIP PNONE STATELICENSE� <br /> P��INGEON ACT R �l�A AES Cltt ZIP PNONE STATELICENSE� <br /> 6 , � , � <br /> c�o RACTPRICEOFWORK HEATING SYSTEM: �AS fl ELECTRIC ❑ <br /> DESCRIBE RN AND SOU�R OOTAGE INVOLVED COYTACT PERSON AN�PNONE NO. <br /> ` r . <br /> /x I.�i I C"iJ�-� f�•-�% � <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> — APPLICATION AND KNOW TFiE SAME TO BE TRUE AND CORRECT.ALL <br /> PP7POSE0 USE OF 9UILDING PROVIS'ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> .�.-.', ;— I � WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRI IONOFPROPER7Y(SHOWNBELOWORATTACHTWo�ri� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GlVE <br /> �or �- BLOCK or �7 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULA�ING CONSTRUCTION OR THE <br /> � '�� � ' ✓� 7 PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � i.. <br /> � OWNER OF THIS PROPERTY TO PERFGRM THE WORK FOR WHICH <br /> i � r-- APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1027 RCW AND 296200 WAC. <br /> PARCEIT ID.NUMBER � " <br /> 1 <br /> �G� �, j � , �%/�'/9� <br /> CONSTRUCTONLOPNLENDER.AUDRESS.TELEPHONENIIMBEH �( '�� , <br /> SIGNATURE "� TE T� <br /> � <br /> CITV BUSME55 LICENSE 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—AMNDLG UNITS—H.P. ' <br /> BATHTU3 ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) I � HEAT PUMP ' <br /> '-� SHOWER � � � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY ; IaANGE HOOD � <br /> CLOTHES WASHER i WATER HEATER ' <br /> URINAL WOOD STOVE � <br /> � <br /> DRINKING FOUNTAIN ' METAL FIREPLACE(WOOD BURNING) � <br /> � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � ' <br /> � <br /> SINK(SERVICE—BAR,ETC.) � / GAS RANGE ' <br /> GAS PIPING i <br /> �� 1 <br /> ; EXHAUSTfAN ' <br /> —•— <br /> � <br /> : <br /> � � <br /> � <br /> � <br /> � <br /> SUB TOTAL 5 � SUB TOTAI 5 i <br /> PERMIT S � PERMIT 5 � <br /> TOTALFEE 5 ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: �9f�`f <br /> FRONT SETBACK �7EAR SETPACK SIDE SETBACK PIAN CHECN NUM�Eli FEE RECEIPT NO. � <br /> T �'P <br /> ���'3��3 �95,�!= �3�� <br /> use zor+�� � ' LOT ANEA VACRNT SITE FEES VALUATION FEE <br /> nres n r+o gpI�DING $5 56Z �U-`� �5-� <br /> HEIGNiLIMITATION ! NO OFOWEILING SREOFOIDGRI '� � <br /> UNITS QSOO S/� L��/•NG f PLUMOING � /��: ' <br />. 7 . . _ . - . B St L'AR/!G �n <br /> 1� � pCGUPANC� NOOFSI0R�E5 OCCUPANTLOAU BASEMENT � MECNANIC�L � C, �(7"� <br />' ' GiiOUP <br /> Q-3 2 /�( 4 nres 4+o ' q <br /> FIREALRMR[O-D REASG4 RODITIONALPIANCHECN _��+� <br /> i <br /> � �� OTHER � <br /> FIflE SPHINKLER REO'U �EASON � <br /> -�/' STAiE BUILDING SUfiCHnRGE � i` � <br /> � <br /> TVPEOFCONST PUNSAPP[10�(EDBY CITYOFEVERETT PU9LIC\YORKS � . ��,'7(� <br /> V T� LOCAL SALES <br /> ,� TAX CODE IS 3105 TOTAL �Ir ' �� � <br /> OATE B / 9 <br />