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APPLICATII.N FOR CONSTRUCI .ON PERMIT <br /> CITY OF E��ERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMULITION �CQ COMBINATION I-I BUILDING f1 MECHANICAL f� Fl.UMBINIi fl SiGN <br /> PROJECT ADDRESS • ry <br /> i �� l ��'7 /�t !�'1 f'(�C I C( 1 <br /> 1 OWNER MAILADORE55 CITV 21P PHONE ' <br /> �ti:r_v I %1�ow��� �/�//s �,at �i1c��'�" er�lt �,�.�R- If�%O �D�-- ='�'=o`-/� <br /> TENANT MAI�.ADDRE55 CITY ZIP PIIONE <br /> � <br /> ARCHITECTORUESIGNER 61AILADI1fiE55 GITY ZIP PMONE <br /> .-LL� <br /> GENERALWNTP4CTOR MAILADUIiE55 GIiV ZIP PHONE STATEL�d@NSE� <br /> -�� <br /> MECNANICALCONTqACTOR MAILADORESS CITV ZIP . PHONE ST�TEIICENSEM <br /> ��- <br /> PWMBINGCONTRACTOR MAILA�ORE55 qTY ZIP PHONE STPTELIGENSE� <br /> _ ' CONTRACTPRICEOFWOfiKf/ <br /> Ji <br /> � S'�� HEATING SYSTEM: ❑ GAS ELECTRIC ❑ <br /> � . DESCRIBE WORK ANO SO,YAFE FOOTAGE INVOWED CONTACT PERSON AND PHON NO. <br /> . _ c �.i�Gl �A'<' IQ�He� e' iN i��� ( � ¢,Nntt`_'� '�``r �"�yl� <br /> /'�cr•, #�.. a /��-� S�• f�- <br /> � ���M �C.�C �j���..f` �.����p��+t��,�-�L I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> R�.yQ �,�u�` PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WO�K WILL BE COMPLIEC WITH WHETHER SPECIFIED HEREIN OR <br /> � LEGALUESCRIPTIONOFPROPERiY�SHOWNBEIAWOflATfA NT4000PIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �or I�� O� ��I' BLOCKO�I—��pF � u2l�v�y'� v AUTHORITV TO VIOLATE O.^ CANCEL THE PROVISION OF ANY <br /> I OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> P l v S Ul�C— I I'e- PERFORMANCE OF CUNSTRUCTION.THAT I AM AUTHORIZED BY TL� <br /> OWtJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICrI <br /> � APPLICATION IS� MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX IA.NUMBER ��� CONTR 6TORS LAVJ 1827 RCW AND 296200 WAC. <br /> s�iu r�- oi� - � r�-c�cx-'o �/ > <br /> CONSTRUCTION LOPN LENUER.ADDRE55.TELEPMONE NVMBER x / :l�7�(,A�e� �.. yZ.�^C�� <br /> ! �G <br /> �-- SIGNnTURE . � DATE <br /> � <br /> . CITVBl15WE55UCENSENO. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEe NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � A/C-AMNDLGUN�TS-H.P. � <br /> � BATHTUB ; FORCED AIR SYSTEMS-B,T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP —�— <br /> SHOWER � UNI'fHEATERS-O.T.U. M � <br /> KITCHEN SINK&DISP i CLOTHES DRYERS i <br /> D�SHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANGEHOOD � <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW FREVENTERS ; GAS F�REPLACE ; <br /> SINK(SERVICE-BAR, ETC.) � GAS RANGE � <br /> I ' GAS PIPING ' <br /> • (.%"��, "�.. i EXHAUST FAN i <br /> .r��,i•� . � � <br /> 1/� � i <br /> � i <br /> � � - - <br /> SUBTOTAL S /' ; SU9TOTAL S � <br /> )'i'. � . �-� PERMIT S � PERMIT S i <br /> �� �� TOTALFEE S � TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> fRONT5ET0ACK �� �F.Tfl _ IOESET CK PLANCHECK�MQS'J / FE��n �T REG���; � /^ <br /> j �� p ✓ ty <br /> T <br /> usez �ornnea VACANi51TF. FEES VALUATION FEE <br /> � _ � fIVES fl NO p�IIDING COO i <br /> HEIGHT LIMIT�TION / NO OF DWLLIING SIZE OF BLDGRI. � � <br /> G UNIT$ ,S �� P�UMpING i <br /> GROUPNCV NOOPSiJ�IES OCCUPANTLOAD BASEMENT MECMANICAL 'O� <br /> '3 /�( �,q ❑ves iY�io , <br /> FIREALAtiM�EO'0 REASON ADDITION�LPLANCHECK � <br /> i <br /> oT„E� � p <br /> FIRESPRINKIERAEOD REASON � <br /> SiATE�UILDItJG SURGN�RGE i <br /> TVPEOFCONST PLANSAPPtiOVG�BY CITYOFEVERETT FlUBLICWOf1K5 � <br /> ' V,�' LOCAL SALES � ., <br /> -hl OATE 3/3i/95 TAX CODE IS 3105 7o7AL _3/zl i <br />