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� ,� <br /> APPLICATIG.J FOR CONSTRUC'i .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> ❑ DEMOLITION I� COMBlIlAT10N fl BUILDING '�MECHANICAL I-1 PLUMBR�G rl SIGN <br /> PPOJECTADDRESS � � C�O �N (�RL �F <br /> owjr��n n+aanoon�ss �vf—C2��4;N Uf2LJ� �V�E.'("� /�� ri��9 r��95 <br /> `J£FF Ss�v���q+,' <br /> IEN�NT A141lFDDPES$ CITV ZIP PIIONE - <br /> A�IITQE O DESIGNER AIAILAD�RE55 CITV ZIP PHONE <br /> GENEF�LCONTRACTOR MAILPDDRE55 . CITV ZIP PHONE STATELICENSE� � <br /> MECHANICALCONTRAC70R MAILAODRESS CITV ZIP PIIONE STATELICENSE� <br /> f�Fna,��,a�� F�n+in�U t��lo2 F}�y� �}vaN�� � � �E.e,�r� 9 �zJ.3 ys 9=4918 ftfs�,DfPEN�+R , 1 <br /> PWMBINGCONTRRCTOP MAILAUDRE55 CIN 21P P10NE STATELICENSEM ((U �N/ <br /> CONTRRCTPRICEOFWORK S y Z� HEATINGSYSTEM: �GAS ❑ELECTRIC ❑ <br /> DESCRIBE WORN AND SOUARE FOOT�GE INVOLVED CONTACT PERSON AND PHONE NO <br /> ?�JO i�l RA�t–EA� L A� FuRN�G�E. "�' �.T d�E2SJ6� <br /> � s �,� c,� w Us �Sv- �g i a� <br /> I HEflEBY CER7IFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.�LL <br /> PROPOSED USEOF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFAROPERN(SHOWNBELOWORAITACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or etocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1027 RCW AND 296200 WAC. <br /> PARCEITA%I.D.NUMBER <br /> CONSTAUCt10N LOAN LENDER,ADORE55.TELEPHONE NUMBER �( �LL"-�l1 � �� � 4� �/i��S� <br /> SIGEIAIiJRE dATE <br /> V <br /> CITV BUSINESS UCENSE 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—A/HNDLG UNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T,UJ{IM E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER � UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS __� <br /> DISHWASHER � VENTILATION FAN ' <br /> RANGE HOOD � <br /> LAUNDRYTRAY � � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVir.E—BAR, ETC.) � GAS RANGE <br /> �— GAS PIPING <br /> � <br /> ; EXHAUSTFAN ' <br /> � C.A�S �-J�r � <br /> � <br /> � � <br /> � <br /> SUB TOTAL S � SUB TOTAL 5 i <br /> PERMIT S � PERMIT 5 � <br /> TOTALFEE S ' TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBaCN RE�R SETU4CK SIDE fETDALH Pl'1N CHEC Nl UER FEE RECEIPi NO. <br /> 7s�i <br /> usezor+e LOTAREA vncnNtsite FE S VALUATION FEE <br /> nves n No OUILOING � <br /> � <br /> HEIGNT LIMITATION NO.OF DWEIIING SIZE OP OIDGRA. i <br /> UNIiS p��)MOING <br /> OCCUPANCY NO Of Si0R1E5 OCCUPANT LOAO O�SEMENi MECMANICAL i <br /> GROUP <br /> fIYES tl NO � <br /> FIfiEALl�RMtiEO'D �EASON AO�ITIONAIPLANCHECK i <br /> i <br /> OTHER � <br /> � <br /> FIRE SPRINNLER REO'0 RE�SON � <br /> i <br /> ST�TE BUILDING SURCHARCE � <br /> i <br /> � <br /> TVPEOFCON51 PV.NSAf'Pf1OVED8Y CITYOFEVERETT PU�1.IC\VORKS � <br /> LOCAL SALES I <br /> DATE TAX CODE IS 3105 TOTAL ' <br />