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r - <br /> APPLICATI�.A FOR �ONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> DEMOLITION Cl COMBINATION fl BUILDING f] MECHANICAL Cl PLUMBING fl SIGN <br /> FFOJECT ADDRESS <br /> (v ' O Cor+1M c A �✓c CU�2E� 9� D3 a,SY - s6 <br /> O ELR MRILADDIRE55 n �ITY ZIP PNOYE <br /> �edl2� � Sc�uc.y�A(,Z�! 00� .�(� th 4T Ft FR.E'/?w.A `7.�2�/ � 02 �S'd� - �/3'� <br /> TENANT MAILA��RE55 CIiY ZIP pNONE <br /> ARCHITECTORDESIGNER MAIL�OOHE55 C17Y 21P PHONE <br /> GENE CONTRACTOR MAILAODRE55 Cltt �IP PHONE STATELILENSEr <br /> i,un-E�L <br /> ME HANICAICONTRACTOR MAILAUDRESS CITV ZIP PHONE STATEUCENSEM <br /> PlUM91NGCONTRACTOR MAILADDRE55 CITV ZIP PHONE STATELICENSE/ <br /> CONTRACT PRICE Of WORN <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORN AND SOURRE F� E INVpLVED CUNTACT PEHSON AND PHONE NO. <br /> f���,o �/8 96 �a �� CA E <br /> I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND OR�INANCES GOVERNING THIS TYPE OF , <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWN6ELOWORATTPCMTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF AUTHORITY TU VIOLATE OF CANCEL THE PROVISION OF ANY <br /> �N SFT(�T !$ 8 � i iN� .J�Sh j��/ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> - UD �4 Y e.ed � o xJ o .t,��yy� OWNER OF TH!S PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION la MADE AND I COMPLY WITH THE STATE <br /> PARCEITA%I.O.NUMBER CONTRACTORS LAW 18.27 RCW AND 2962 WAC. <br /> y49 —0/3 -016 - Uo3 I/ 5aU (� � <br /> CONSTRUCiION LO�N LENOER,ADDRE55.TELEPHONE Nl1A1BER /Jf�Q <br /> p (� $IGNATURE DATE�-�� <br /> Se�T FIrNANCIM �(�Q LQ/Vd!"-�L <br /> O� CITY BUSINESS IICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYEFlS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ' <br /> � <br /> CLOTHES WASHER i WATER HEATER � <br /> URiNAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLAOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> � BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> , SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' ' GAS PIPING ' <br /> i EXHAUSTFAN i <br /> � i <br /> � i <br /> � i <br /> i � <br /> SU8 TOTAL S ; SUB TOTAL 3 � <br /> PERMIT 5 i PERMI? S � <br /> TOTAL FEE S � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCN REAq SETBACK SI�E SETDACK PIAN CNECK UMOER FEE RECEIPT NO. <br /> b-3�=' <br /> usezor+e LOTAREA VACAt�T51TE FEES VALUATION FEE <br /> nvEs n r+o ow�owc I <br /> � <br /> NEIGMT LIMITATION NO.OF DWELLING 52E OF BLDG?.I. i <br /> UNITS PLUNOING i <br /> OCCUPA!.CY NO Of Si0RIE5 OCCUPANT LOAD BASEMENT � <br /> GROUP MEGIIANICAL i <br /> ❑YES Il NO i <br /> FIREAURMRE�'0 REASON AOOITIONALPLANCHECK i <br /> OTHER i <br /> FIRE SPPINNLER REO'D REASON i <br /> STATE OUILOING SURCHPIIGE j <br /> TVPEOFCONST PLANSAPPROVEDBV CITYOFEVERETT PUOLICWORK$ i <br /> LOCALSALES <br /> onre TAX CODE IS 3105 TOTAL ; <br />