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APPLICATION FOR CONSTRUCTION PERMlT <br /> CITY OF EVERETT• BUILDING DIyISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION f i COMBINATION � fl BUILDIN� fl MECHANICAL PLUMBING f l SIGN <br /> PROJECTADDRESS ���i SL GU�� ri��/I• L�' \ � � t <br /> � eti_ .�rwii�- t� IG7N�l <br /> �'ow r�c+, Mnanooaess cm zm rNONE�r <br /> f IU1 t,fJ_.i �0� S 1� �-�(�' ���'I �D �a. �!Z/�`� /Oe2� ' O�UD <br /> TENANT t' MAILADDRE55 CITY ZIP PHONE <br /> _�eu i-,�..., a� <br /> ARCHRECTORpE51GNER MnILA0DRE55 �ITY 7.IP PHONE <br /> GENEttpl WNiPnCTOR MnILAD�RESS �IIY ZIP PH04E S7AiE LICENSE• <br /> I� �� <br /> MECHANICAICONiRAC70P MAILADORFSS CITV ZIP PHONE STATEUCENSE� <br /> PLIIMBINGCONTPaCTOR MaILA�ORE55 CITV 21P PHpNE STATEIICENSE� <br /> �q,v,c �orcl Plw�e 'di4U�/ NC Il5 S}�. �PG{�na��cl Wq �i'�053 2ab g8�1 d3bl G.At�Gf'�� l/g2g <br /> coNrnncr raice oF wonrc <br /> HEATING SY�TcM: ( 1 GAS rl ELECTRIC f l <br /> DESCRI9E WOHK ANO SOUARE FOOTAGE INVOLVED CONTACT PERSON ANO PIIONE NO <br /> � ed � -o -cl 1eG g�a b361 <br /> I HEREBY CERTIFV THAT I HAVE R°AD AND EXAMWED THIS <br /> PPOPOSED USE OF 9111LDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHcC7 ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEGFLDESGR11'TIONOFPROPERTV�SHOWNOELOWORATIACMTWOCOPIES� NO7. 7HE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br /> �ot BLOCN 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�UTHORiZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX ID.NUMBER CO/NTR�ACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTPUCTION tORN LENOE{i.ADORE55,i[LEPNONE NUMBER x 7�TJ� (J�� �v �.� ��/��/C��� <br /> SIGNATIIRE�n n„/�� pATE <br /> �'f/� <br /> CITV BUSWE55 LICENSE N0. <br /> PLUMB7NG MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. <br /> DATHTUB � FORCEDAIRSYSTEfv1S—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 ; CIOTHES DRYERS ; <br /> DISHWASHER � VENTI�ATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ' <br /> CLOTHES WASHER WATER HEATER <br /> URINAL � WOOD S7�OVE <br /> DRINKING FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SER\%ICE—BAR,ETC.) GAS RANGE <br /> � GAS PIPING � <br /> EKHAUST FAN i <br /> i � <br /> i i <br /> � <br /> —T <br /> SUB TOTAL 3 � � SUB TOTAL S � <br /> PERMIT S � i - PERMIT 3 � <br /> TOTALFEE S re. �� TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONTSF.TAAf,N PEABSF.iPACN SIDESETBACN PtANCHECNNUM �EF �[f.FIPTNO. <br /> SO/�O <br /> usezor+e toraaen vncanrsrte FEES VALUATION FEE <br /> i ives r� No ouiioiNc I <br /> � <br /> HEIGNTUMITATION NO.OFDWELLING SIZEOFBLOG/TI <br /> UNIiS <br /> PlUN01NG <br /> OCCUPANCI NO Of StOPiES OCCUP4NT LOAD BASEMENt piECH/NIC4L ` <br /> GROl1P <br /> f1YE5 I1 NO - <br /> FlqEALARMREOD �EA50Y AD01110�lPLPIANCHF.CK <br /> ��__ <br /> OiME(i <br /> i <br /> FlRF SPRINKI.ER REO❑ RE4SOt! <br /> SiNE DUIlOING SURCIIMGE <br /> i <br /> rvrEOFcoNsr r�nvs<rrnovEoor CITYOFEVERETT runur,wonKs <br /> LOCALSALES - <br /> ��q,�_ TAX CODE IS 3105 TOTAL <br />