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APPLICATII,N FOR CONSTRUCI �ON PERMiT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> I-1 DEMOLITION fl COMBINATION i I BUILDING G VIECHANlCAL Cl PLUMBING I-1 SIGN <br /> PROJECT ADDHESS `�a $a /�/�' (^t <br /> J G U <br /> �01 y.cR MnILADDfiE55 Cltt z�p pHONE <br /> /(06�r�' ��a^ �Ds� 34�8�^�jh j'f, �✓t�v��i� (.r.le 9'p.to3 ,ZS'3-S�6.Z <br /> TENnNr MnunoonEss arv zia f r��orve <br /> ARCHITECTOR�ESBNER MAILADOfiE55 GIIY ZIP PHONE <br /> GENEf1ALCONTRACiOR MAILAOOfiESS CITV ZIP PHONE <TATEUCENSE� � <br /> MECHANICAL CONTFACTOR MAII ADDRESS -y CITY IIP PIIONE STATE LICENSE� <br /> /q7hl�"JC d H D�J7f �e ?S'09 N�'addtcidi �vc�f'i7'�f Ww 9PlU/ A�i,��'k/�C ss i�Dy <br /> PLUMBINGCONTR�CTOR MNLA�DRE55 CITY �— ZIP� PHJNE STA7ELICENSE� <br /> CONiRACT PRICE OF WORN � <br /> �(� � HEATING SYSTEM: vl'L;AS ❑ ELEC''RIC ❑ <br /> DESCRIBE WORK ANO SOUARE TAGE INVOLVED CONTACT PERSON ANO PIIONE NO <br /> '� � f �1�.2 � <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUII.DING APPLICATION AND KNOIY TI1E SAME TO DE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGRLDESCRIPTIONOFPROPERTV(SHOWNBELOWORATTACl/TWOCOPIES) NOT. THE GRANTING GF A PERMIT DOES NOT PRESUME TO GNE <br /> �or BLOCK or AUTHqRITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEp 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 /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PANCELTA%1.0.NUMBER CONTRACTOFS LAW 1827 RCW AND 296200 WAC. <br /> CONSiRlICiION LOAN IENDER.PDORE55.TELEPNONE NUM�ER X �� (.I� ��/�Q��/ <br /> SIGNAiURE��r�' — � DATE <br /> 'I <br /> CIN BUSME55 LICE�ISE NO. <br /> PLUMBINO MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. —T <br /> BATHTU[� ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP —T <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER T— <br /> .— <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i� <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE ' <br /> � <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE � <br /> GAS PII'ING ' <br /> i EXHAUSTFAN i <br /> � i <br /> � i <br /> � � <br /> � � <br /> SUB TOTPL 3 � SUB TOTAI $ j ; <br /> PERMIT 5 � PERMIT S /,S � <br /> TOTAL FEE S � TOTAL FEE $ (l� � <br /> FOR OFFICE USE ONLY: <br /> FRONT SEIUACK PEAR SETBACN S�DE SETOACK PLAN CH[CN NUMOER FEE RECEIPT NO. <br /> usezoNe �ornnen V4CRNTSIiE FEES VALUATION FEE <br /> nves n No OUILOMG I <br /> HEIG!IfIIIAT�TION NO.OFDWEIUNG SIZEOFOLOG/T.I. � <br /> UNITS PLUMOING i <br /> OCGUPANCY NO OFS70RIE5 OCCUPANTLOAD BASEMENT � <br /> GROOP M[CIIRNICAL i <br /> ❑VES fl NO i <br /> FIREALARMREO'D REASON ADDI710NFLPLANCMECN j <br /> i <br /> OiNER i <br /> FIRE SPRINKLER REO'0 PEASON � <br /> i <br /> STATE DUIIOMG SURCHAflGE j <br /> i <br /> TVPEOFCONST. PV.NSAPPROVED�Y CITYOFEVERETT PUBLICWOfiKS � <br /> LOCAL SALES , <br /> �AtE TAX CODE IS 3105 TOTAL i <br />