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. APPLICATIu�N FOR CONSTRUCl10N PEF�MIY <br /> CITY OF EVERETi• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> rl DEMOLITION rl COMBINATION CI BUILDING f7 MECHANICAL ❑ PLUMBING SIGN <br /> PROJECT ADDRESS /�O�`j S� �J� ��/l � <br /> OWNER lAAILADORESS Cltt 21P '110NE <br /> � e �1E - T ' - "'[3P NA[�� GT C� .� <br /> IENPNT <br /> MAl1.AD�RE55 �CITV ZIP FHONE <br /> P` CITV ZIP PHONE <br /> ARCMRECTOROESIGNEH MRILFODPESS I ` C��/�}1 /// - _ � <br /> J ,� c d�� <br /> Cn��r�NE�-�' L �1�G�1S ��i �Z�"y'Z /"'�- Iy11FF�Il�^LL� /G/� �f�"lG'ONE STATEI ENSE1 <br /> GENEBALCCNTRACTOR MAILAO�RESS ys-�_�•7�J <br /> !�. / <br /> MECHANICALI:ONTRACTOR �.�A�LPDDAE55 <br /> CITY ZIP PIIONE STATE IICENSE Y <br /> �� ��TM Z�p P/IONE STATE UCENSE N <br /> P/LUAIBINGCONTFiACTOR lAAILADORESS <br /> y �j _ <br /> CO. RACTPRICEOFWOAK HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> CONT/+ TPERSONANDPIIONENO. <br /> DESCRIBEWORKANDSOUAFf:F00TAGEINVOLVEO! ` ��G�, --SL ;. 1/��� �f�jL{-����GJ <br /> �L�/V Tb M � iliL <br /> r,or�r�i rT EXlST, '--t � <br /> y <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMlNED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSEDUSE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> G F WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIN OR <br /> LEGAL�ESCRIPTIONOFPROPERTY15110WN�ELOWORATTACHTWOCOPIES) N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PFiOVISION OF ANY <br /> �or OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOF YlHICN <br /> ' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AAD 296200 WAC. <br /> PARCELTAXI.D.NUTABER /� / <br /> � /U/ i/r /�i�d7i1�.1�/Q�L. / %//�'�— <br /> CONSTRUCTION LOAN LENOER AODflE55.TELEPHONE NUMOER T RE DATE <br /> 02 �� �� <br /> CITYBUSINE$$LICENSE� O. <br /> PLUMBING MECHANICAI. <br /> FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> Np TYPE OF FIXTURE OR ITEM i <br /> WATER CLOSFT(TOILET) � NC—AIHNDLG UNITS—H.P. <br /> � FOfiCEDAIRSYSTEMS—B.T.U. M E.A. �_ <br /> EIATHTUB ' - <br /> � <br /> LAVATURY(WASH BASIN) i HEAT PUMP ---.— <br /> � UNIT HEATERS—B.T.U. M <br /> SHOWER � � <br /> KITCHEN SINK&DISP � CLOTHES DRYERS <br /> i VENTILATION FAN � <br /> DIS{iWASHER i RANGE HOOD ' <br /> LAUNDRYTRAY ' <br /> _ � WATER HEATER � <br /> CLOTHES WASHER � <br /> URINAL � WOOD STOVE <br /> � <br /> DRINKING FOUNTAIN ' <br /> METAL FIFEPLACE(WOOD BURNING) � <br /> � FIREPLACE INSERT(WOOD BURNING) ' <br /> FLOOFi DRAIN ' <br /> � GAS FIREPLACE ' <br /> BACKFLOVJPREVEMTERS � <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING � <br /> i <br /> ' EXHAUST FAN � <br /> i , <br /> � � <br /> _ � � <br /> � , <br /> SUB TOTAI $ � SUB TOTAL S i <br /> PERMIT S �_ <br /> PERMIT "� ' TOTAL FEE e ' <br /> — TOTAI FEE S ' _ <br /> FOR OFFICE USE ONLY: t�eceiarr+o. <br /> PLAN CI E MOE(i FEE `?Q � <br /> FFlONTSETDACR REAR SETDACK SIDESETBACR � Jy _ <br /> FEES VALUATION FEE <br /> USE ZONf� ' � LOTAREA VACANT SITE � i1�� <br /> i J Il VES n NO BUI�DING �J O� ` V <br /> i <br /> i <br /> HEIGIITLIMITATION UNIiSF�WELLINu 512EOFOLDGRI. p�UMUING <br /> i <br /> MECIIPNICAL � <br /> OCCUPANCY NO OF STOFIES OCLUPANT LOPO OASEMENT — ___ ' <br /> GROUP �7YE5 ll NO � <br /> qD01T10NAL PLAN CHECK � <br /> � <br /> FIREPLARMREO'0 AEASON i <br /> OTIIER � <br /> i <br /> FIRE SPRINKLER FEO'D FEASON � STATE OUILOING SUIiCHARGE i-�� <br /> TVPEOFCONST Pll�NS PROVEDBY CITYOFEVERETT PUBIICWORKS � <br /> I� LOCAL SALES _ J I�� <br /> oAT O- _g TAX CODc IS 3105 TOTAL <br />