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r� � <br /> APPLICATI�..�1 FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> fl DEMOLITION fl COMBINATION �1 BUILDING '� MECHANICAL 1� PLUMBING fl SIGN <br /> PROJECT ADDRESS �, n C� <br /> � �1% �f' '�) � � �1�. �.��^J <br /> 01YNER MAILOfppE55 Cltt ZiP PHONE <br /> �,LJek�so�a 3oS CCnw�+ �1L �i�eJ'eff- �1/2 98?.03 W'. 3•� -973�f l� .' 3S�-3ybo <br /> 1ENPNT MAILADDPE55 CITI 71P PHONE <br /> Dcsc�N �,uEs 19is Man�soN sr E�.>_r�N WA 9s�aa 353- 053� <br /> PRCN�TCCTORDESIGNER MAILA110fiE55 Glry ZIP PNONE <br /> !�� ioSos 3s�^ D, Uc m�r�T,,,il� L��A �i8z�o 6s4 - �t,z�( ine�+�tiwlz3K�' <br /> GENER�IC N �GTOR MnIL ORESS C�TV 21P PIIONE S7NEUCFNSE� � <br /> ���a.��=z2 �(1rJ0��c� S/r/� <br /> MECHANICALCON7IlACTOR MAILADDRE55 CITY 21P PHONE STATEIICENSE• <br /> PLUMBINGCONTRACTOR MFILADUFE55 CI7V ZIP PNONE 51ATELICENSE� <br /> CONTRACT PRICE OF WORK <br /> HEATING SYSTEM: DQ GAS ❑ ELECTRIC C7 <br /> DESCRIBE WORK AND SOUARF.FOOTAGE INVO�VED �gy b) µ CONTACT PEPSON AND PHONE NO. <br /> _� �'fW{N IU7b d � nup <br /> Ann u�l�pr� S�u�r.aom � s� �1 <br /> �'othL _ Zya G��t, i HEREBY CERTIFY THAT I HAVE FiEAD AND E%AMIIJED THIS <br /> PROPOSE�IISE OF BUILOING APPLICAlION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEqNING THIS TYPE OF <br /> SwuP�nn�+2 - bFf-Ito— WORK WILL FE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> LEGRLDESCRIPTIONOFPROPERIV(SHOIVNBELOWOFATfACHTWOCOPIES� NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tot S� BLOCKOro'D-OD oF AUTHORITY TO VIOLATE OR CANCEL iHE PROVISION OF ANY <br /> OT!iER STATE OA LOCAL LAW REG�JLATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTFIORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE 'NORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUVBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> 6o bl - o - o - 000s /� <br /> CONSTRUCTION LOAN LENDER,ADORESS.TELEPHONE NUMBEP CW� �-/�[w�,� 3��J- yS <br /> _ I NATU9E —� onTe <br /> GITV OI151NE55 LIfU.SE 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—AMNOLG UNITS—H.P. ; <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) i HE1.T PUMP � <br /> SHOWER ' UNIT HEATERS—B.T,U. M ' <br /> K�TCHEN SINK&DISP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATEP. � <br /> URINAL ' WOOD STOVE ' <br /> . DRINKING FOUNTAIN � ME fAL FIREPLACE(WOOD BUFNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFIOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE <br /> ' GAS PIPING <br /> � EXHAUST FAN � <br /> i — <br /> — — i i <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL S ; <br /> PERMIT 5 i PERMIT 5 � <br /> TOTALFEE 5 � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: �P �`- <br /> Fi70NT SETIIACK , RE�R SFTOACK SIOE SETORCK PUN CNEC NUM[fF.R FGE /� FECEIP N� <br /> Z� C�� �J'�' �G3�� <br /> usezor+ �ornaen vncnNrsrte FEES VALUATION FEE <br /> �� � �� {'fYES fl NO BUILDING 1� �� '� � �7 � <br /> )C/. ����J /� � � i <br /> HEIGNTIIMITATION NOOFOWRLING SIZFOF�IDG�fI � <br /> uNirs � /56 S,f� cffi4� r�urneirvc � <br /> o S� J'✓,.� ICa'.ti —�---- <br /> OCCUPANCY NOOFSi0RiE5 OCCUPANRO�D OASEMENi M[LHANICAL j <br /> GROUP <br /> � IlVES fl NO i <br /> FIRE PLARM REO'D REASON ADDIiIONAL PLAN CH'cCK <br /> / i <br /> OTHER � <br /> FIHE SPRINKLER REO'D FFASON i <br /> j STNEOUILOINGSl1RGN�fiGE � i,.� � <br /> i ' <br /> TYPEOFCONSI PIANSAPPROVEDUY CITYOFEVERETT ruoucwonKs � <br /> ��v ��� LOCALSALES — <br /> � <br /> ) onte i'/1� •�� TAX CODE IS 3105 TOTAL � 1,2 j <br />