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. , <br /> APPLfCA71�.� FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f7 DEMOLiTION �l COhIBINATION f7 BUILDING MECHANICAL Cl PLUMBING fl SIGN <br /> PROJECT ADDRESS n <br /> \ � 1 � — �T' �- I��AiJ . ?� �J� i%, t�JF� � � er " �'Lk?iT <br /> OWNER JMAILAODRESS CITY ZIP PHON <br /> F' � 2 2 n ►s�oo y u�. fF��1'tih �9�:�. � <br /> 1l?�T i.�T�t2 7tQ-A-- U�..3�� "CJA.� ,� PpO�(�i 17 �"i g',��� �-, � nn itr� A � <br /> TENFNT��_ 61FILADDRE55 CITV 21P PHONE <br /> 7u>g <br /> ARGHITECTOR�ESIGNEP MAILADORE55 CIN ZIP PHONE <br /> �3 2SS—Z3? <br /> s <br /> GENEPALCONTAACTOR MAILADDFiESS �IL CI� ��'JZ�p � ^ PMONE STATELICENSEa �;� V "bJtS <br /> g�S Coa�hi(�v T�orJ � �`-' 0 ��� .-� Cv3L—l`j`r I ,. <br /> , � ,e�. ,x -�.i��3 � <br /> MECH�NICAL CONTRACTOR MAIL ADDPESa ^ ZIP PHONE STATE LICENSE/ <br /> ��IQ7 t.I�R.ciT{�V ' `:.�1 <br /> 8���aa�.� M��- �v�c ^ Ss�r3-r"ri-c! � ,o.-- �a�iu�n 7t�7 -79�r�; MF�c.9ot�`�t�'�",�1 <br /> P�UMBINGCONTRACTOR MAILAD�PE55 CITV <br /> ZIP PHONE STATE LICENSE Y <br /> CONTRFCT PRILE OF WORK <br /> Lr�p <br /> Qj�(] HEATING SYSTEM: f l GAS �tLECTRIC ❑ <br /> DESCRI�EWORKAN�SOU REFOOiAGEINVOLVED CONTACiPERSONANDPHONENO. � �� � C� � <br /> I cr � � C �,� <br /> ��1.� �l.oc,$T'� � T— ' 7 <br /> �� (���-j�� �, � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PqOPOSED USE OF BUIIUING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.P.LL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK VJILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALOESCRIPTIONOFPROPEflTV�SHOWNBELOWORAITACIITWOCOPIES) NO?. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUl4TING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTIOfI,rHAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPE7TY TO PEHFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTAX I.D.NUMBER CONTR CTORS LAW 1827�9CW AND 296.200 WAC. <br /> CONSTflUCT10N LOAN LENOER,A�ORE55,TELEPHONE NUMBEH X � �� � 3�Z'��j <br /> SIG ATU OATE <br /> CITV BUSMESS LICENSE NO. � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM FEE N0. TYPE OF FIXTURE 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) i HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN i <br /> LAUNDRYTRAY ; RANGEHOOD ' <br /> i <br /> CLOTHES WASHER � WATER HEATER —� <br /> URINAL ' WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPIACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIPEPLACE ' <br /> i <br /> SINK(SERVICE—BAR, ETC.) � GAS R.4NGE � <br /> ; GAS PIPING � <br /> � EXHAUSTFAN i <br /> � � <br /> i , <br /> � , <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL S ' <br /> � <br /> PERMIT S i PERMIT $ � � <br /> TOTAL FEE 3 � TOTAL FEE S ' ' <br /> FOR OFFICE USE ONLY: <br /> fRONT SETBACH REAP SETBACK SIDE SETBACK PLAN CHECK NUMOER FEE RECEIPT N0. <br /> usezone IOTAREA vncnHtsirE FEES VALUATION FEE <br /> nves ❑ No ouamNc I <br /> � <br /> HEIGHTLIMITATION NO.OFDWEIUNG SREOP�LDGRI. � <br /> UNITS <br /> PLIIMpING � <br /> i <br /> GROUPANCV NOOFSi0RIE5 OCCIIPANTLOAO BPSEMENT MEGHFNICAL i <br /> ❑YES f1 NO � <br /> � <br /> FIREAIAflMREO'0 REASON <br /> ADDITIONFI PLAN CHECK � <br /> OTHER i <br /> FIPE SPRINKI.ER HEO'D REFSON <br /> i <br /> i <br /> STATE�UILDING SURCHFRGE � <br /> TVPEOFCONST PLANSAPPROVEDBY CITY OF EVERETT PUBLICWORKS —r— <br /> LOCAL SALES <br /> DA1E TAX CODE IS 3105 70TAL ', <br />