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r� _ <br /> APPLICATII.N FOR CONSTRUCI �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•8810 <br /> f7 DEMOLITION fl COMBINATION ,�I'BUILDING fl MECHANICAL n PLUMBING fl SIGN <br /> PROJECT ADDRESS - <br /> G� `�/6 j,l�,'o� !�t/o <br /> OWNEP MAILAD�RESS CITY ZIP PHONE <br /> r <br /> � ,•�, 6' H� — oo���°l. SE F��irr� y'���1 3^sfr -�/l�l <br /> 7ENANT • M�ILADDFE55 QTY ZIP PHONE - <br /> �M A)�('� =�/ SkS�r <br /> ARCHITECTOR�ESIGNER Mu�A0DRE55 ��Ty Z�p �PXpNE -. <br /> GENER�LCONTRACTOR MIJLADORESS CITY 21P, PIIONE STATELICFNSE� <br /> Dr.ViU£}Q . <br /> MECHANICAICONTRACTOR! M�ILADORE/SS I CITV 21P PIIONE ,/ STATEIICENSE/ <br /> L-vc��TPNN Jf f1wv7'u. 7� � .ZSv'Z 3��7 <br /> PLUMBING CO R�CTOR MAIL ADDRE55 CITY ZIP PHONE STATE UCENSE� <br /> /f � r - �' � <br /> CONTMC ICE OF WORK <br /> HEATING SYSTEM: f�GAS I'7 ELECTRIC fl <br /> DESCRIBE K AND SOU�RE OOTA6E�r VOLVED CONT�CT PERSONAND PHONE NO. <br /> I . <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERiY�SHUWNBELOWpiATT�CHTWp[OPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or aiaK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> �L�N � a C �O / _ PERFORMANCL- OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> ' OWNER OP THIS PROPERTY TO PERFORM THE WORK FOR WMICH . <br /> APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> PMCEL'A%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION L01N IENDER.�ODRESS.TELEPHONE NUMBER x � � 7� <br /> N URE D�TE <br /> I BUSINESS LICENSE N0. <br /> PLUMB�N6 MECHANICAL <br /> NO. TVPE OF FU(TURE Oti ITEM FEE NO. TYPE OF EGUIPMENT PEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDL6UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. ;— <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWEH � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP ; CLOTHES DRYERS ' <br /> � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD ' <br /> CLOTHES WASHER � WATER HEATER �— <br /> URINAL � WOOD STOVE � <br /> DRINNIN�FOUNTAIN � METAL FIPEPLACE(WOOD BURNING) ; <br /> FLOOR ORAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUST FAN i <br /> � <br /> i � <br /> � � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL $ ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S � TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETB�CK , $IDE SEIOACI� GL CIIECN NUMBER FEE RECEIPT N0. <br /> 0 2o S p 1 .53 ,Z <br /> usezon[ LOT�FEA V�CANISILE FEES VALUATION FEE <br /> . �� ' YES f i NO BUILUING i <br /> i <br /> NEIGHTLIMI T N NOOFDWEIUNG SIIEOFBLOGRI <br /> C � UNIfS P�VMDING i <br /> OCCUPANCY Np0�5fOWE5 OCCUPANTLO�D BASEMENT MECHANICAL --~_ <br /> GROUP <br /> ' f1YE5 fl NO � - <br /> FIREAURMqEO'D RE�SON AOOITION�IPL�NG�ECK � <br /> � <br /> OTHER � <br /> FIqE SPPINNIER REO'D REASON � <br /> STAIE OUIl01NG SURCN�RGE � <br /> f� <br /> iYPEOFCONST PLANSRPPROVEDBY CITYOFEVERETT �UBLIf,WOfiKS <br /> LOCAL SALES — <br /> Or1TE TAX CODE (S 3105 TOTAL ; <br /> 5S 21'�) <br />