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APPLICATIO�.d FOR CONSTRUCT JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> i7 DEMOUTION Cl CO►dBINATION f7 BUILDING f-1 MECHANICAL f l PLUMBING fl SIGN <br /> PROJECTADDRESS �//� <br /> ��� � G�� <br /> OWNE MnILADDRESS �Itt�^ ZiP p110NE <br /> � � � �� !N� <br /> 7ENRNT M ILA�ORE55 � CIiY PI/ONE <br /> '����G�� "T_' <br /> ARCHITECTOR�E NER MAILAODRESS CITY IIP FNONE <br /> GENERAICONTRACTOR MAILROORE55 CITV ZIP PHONE SIATELICENSE� <br /> MECHANICAI CONTR�CTOR MAIL AOURE55 C17V Zlp PIIONE STATE UCENSE r <br /> PLUM GCON!JTRA iOR��/) IJfJLA0DRE55 diV ZIP PHONE STRTELICENSE� <br /> � 'C �t/.�.5� <br /> CONTRAC RICE OF WORK , <br /> HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> DESCRIBE WORN AND SOIIARE FOOTAGE INVOWEO CONTACT PEli50N AND PHONE NO. <br /> � � �/�-rC..� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vaoroseo us F e toM APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Y� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �eo��oesc ❑ OFPROPERTY�SHOWNBELOWORATfACNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE . <br /> tor BLOCK__OF AUTHORITY TO VIOLATE OF 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 PEFFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE D I COMPLY WITH THE STATE <br /> PARCEITN(I.O.NUMBER CONTRA RS 1 . AND 296200 WAC. <br /> CONSTRUCTION LOAN LENOER.ADDRESS.TELEPNONE N�MBER X �/�� <br /> SIG AT R DATE <br /> CIN BUSINE55 LICENSE NO. <br /> PLUMBIN6 MECNANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FIXTUflE OR ITEM FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACF(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GASFIREPLACE i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> � EXHAUST FAN � <br /> i � <br /> � � <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ 7 � SUB TOTAI 5 � <br /> PERMIT 5 � � � PERMIT $ � <br /> TOTAL FEE 5 � ' � TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAFl SETBACK SI�E SETOACK PIAN CNECK NUMB[R fEE RECEIPT NO. <br /> �1��lro <br /> usezoNe �oTnnea VACA�TSITF FEES VALUATION FEE <br /> flVES fl NO p�IL�IN(: � <br /> i <br /> HEIGHTLIMITATION NOOFOWEItJNG SIZEOFBLOGRI. i <br /> UNIiS p�UM01NG i <br /> OCCUPANCY NO OFSTOPIES OGCUPANTLOAD �ASEMENT MEGHANIC4L � <br /> GROUP <br /> ❑YES fl NO � <br /> ADDI➢ONAL PLAN CH[CK i <br /> FIRE RLRHM REO'D H[ASON � <br /> i <br /> OTHER � <br /> i_ <br /> FIRE SPRINNLER fiEO'0 REASON � <br /> SiATE OUILDING SURLHARGE I <br /> naeoFcor+sT rur+snriwoveoev CITYOFEVERETT ruoucwonKs � <br /> LOCAISALES � <br /> pAT� TAX COQE IS 3105 TOTAL j <br />