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APPLICATIV�1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA�J8201 •259-8810 <br /> fl DEMOUTION fl COMBINATION fl BUILDING rl MECHANICAL � 1 PLUMBING fl SIGN <br /> PROJECT ADDRESS q � �/ �ve J� /� u � <br /> o� V��. T7 <br /> A I' MAIL�DDRE55 _ , CITY IP (�, Cs PIIpNE / <br /> �L. Q��c�� � �1G 'J 2G�21�w �VGIYi� 762 U � ��j Z—s�0 3 � <br /> �T ANT MAILADOPESS CITV pIP PMONE <br /> ARCNITECTORDES�GNER MMI.AU�RE55 QTV llP PNONF. <br /> GENERPICONTRpCTqi MaIL�WRESS q1Y 21P PIIONE STATELICF`:SE� <br /> C�LW// V_V <br /> MECNRNICRL CONTHACTOR MRIL A�DRESS GiV 7.IP PIIONE STATE IICENSE� <br /> PLUMBINGCONTRACTOR MRILADDRE55 Gtt ZIP pHONE STATEL�CENSE• <br /> WNTR�CT PRICE OF WORK <br /> HEATING SYSTEM: f l GAS f�ELECTRIC fl <br /> DESCPIBE WORK AND SOUARE FOpTAGE INVOWED CONTr1CT PERSON AN�PNONE N0. <br /> I HEREBY CERTIFY THAT I HAVE R!:AD AND EXAMINED THIS <br /> PRpppSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN G(i <br /> IEG�L0E5CRIPTIONOFPROPER7Y�5HOWNBELOWOR�TiACHTWpCOP1E5) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor e�ceK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> O7HER 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 WORY. FOR WHICH <br /> APPLICATION IS`�MADE AND I COMPLY WITH THE STATE <br /> PAqCELTN(ID.NUMBER CONT�CTO/�$ Qrv )8.27 CWAND296200WAC. <br /> // �� <br /> CONSTRUCiION LOAN LENDER.�DDRESS.TELEPMONE NUMBER �L % <br /> GNrlf RE DATE <br /> Cq4 USINE55 UCENS[NO. <br /> PLUMBING � HANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE O. iVPE OF EpUIPMENT FEE <br /> WATEHCLOSET(TOILET) � !VC—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TAAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> UFINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FIOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUST FAN � <br /> i � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL S � SUB TOTAL $ ; <br /> PERMIT S � PERMIT $ � <br /> TOTAL FEE $ � TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETP�CN RERRSETBRCK SIOESETBACN PL�NCIIECKNUMOGR FEf RECGIPTNO. <br /> usezoNe LOT�REA VACANTSITE FEES VALUATION FEE <br /> T <br /> fIVES If NO � ��y <br /> [fUIIUING <br /> � <br /> HEIGHTLIMIUTION NO OFUWELLING SIZEOFBLIIG/fi � <br /> UNITS PWMpING i <br /> T <br /> OCCUPANCY NO OiStORIE$ OCCUPANTLOAD BASEMENT � <br /> GROUP M[C114NICAL � <br /> f1YE5 I1 NO <br /> FIRE ALARM fiEO� RFASON �UUI110NA1 PLAN GHF.GK � <br /> OTIIE41 � <br /> i <br /> FIRF.SPRINNLERREO'D RFASON <br /> i <br /> STN[OUIl01N0 SURCNMGG i L� <br /> Trreorr,oNsr PinNsnrrnovEnm CITYOFEVERETT runur,wonres � • <br /> I <br /> LOCAL SALES �— <br /> onrE TAX CODE IS 3105 TOTAL ��i <br />