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A,PPLI�/�T10.� FOR CONSTRUIC'1'�.1WI PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> ;i200 CEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> �l DEMOLITION fl COMBINATION fl BUILDING I� MECHANICAL f� PLUMBING rl SIGN <br /> PROJECTADDRESS / .��/ _� �J� �,n�// `�� <br /> �' //�/ <br /> ownEn , �� <br /> � l AODRESS CI�L Zip PNONE <br /> �f �c�� o ia� � �� � l� ��o�� ���- ini� <br /> IENANT q pDCR S CITV ZIP P/1ONE <br /> / ��• (� <br /> ARCHI(ECTOB�E,IGNED M�AD�RE55 CITV ZI: PMONE <br /> GENERM.CONTPACTOR MRIL p�ORL55 CITY ZIP OHO4G STAiE LICENSE r � <br /> 61ECHANICALCONTRACTOR MAILAODRE55 CIfV 21P PHONE STATELICEN�E� <br /> PWMBI GC44Jqp TOR MAI AOgRE55 Cltt ZIP PHONE STATELICENSE� <br /> �� - �<� ,�/�� � a- <br /> CONTRACT�qICE OF WOBN i� <br /> HEATING SYSTEM: ❑ GAS fl ELECTRIC ❑ <br /> OESCFI9E VlpRN AIJD SOIIAFE FOOTAGE INVOLVEO COYT�CT PERSON ANO PHONF N0. <br /> �/LK(�( /�.V15/ dV�. lC.�B �� (���J " �j?', <br /> L. �':O <br /> � HEREBY CERTIFY THAT I NAVE REAG AND EXAMIIJED THIS <br /> PR�POSEf1 US oF i oin APPLICATION AND KNOW TH[ Sl�ME TO BE TRUE AND CORRECT.l,LL <br /> PROVISIONS OF LAWS AND OR6INANCES COVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br /> LEGALOESC PTIONOFPROPERTY�SHOWNBf.IGWOR�TfACMTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot BLOCK.__pF AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR�IANCE OF CONSTRUCTION.THAT I AM AUTHOFIZEU B`!THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADF AND I COMPL� WITH THE STATE <br /> PAPCELTAX I.D.NUAiBER CONTFiACTORS LAW 1E27 R y/��AND 296.200 WAC. <br /> CONSIRUCTION LO�N LEN�ER,ADDP:55.TELEPNONE NUMDER X ���'"��\ �.�V�' i.K/ / _��' -IC�S <br /> dIGNAIURE OF E <br /> CITV BUSME55lICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF FIXTURE Oq ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDL�UNITS—H.P. � <br /> _ BAI�HTU9 ; FORCED AIR SYS"fEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNITHEATERS—B.T.U. M �— <br /> KITCHEN SINK&DISP ! ; CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN <br /> LAUNDRY TRAY ' RANGE HOOD � <br /> CLOTHES WASHER N:ATER HEATER <br /> URINAL WOOD STOVE � <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE ; <br /> _ SINK(SERVICE—BAF, ETC.) � GAS RANGE �— <br /> ; GAS PIPING <br /> � EXHA�"��T FAN � <br /> � � <br /> — � � <br /> SUF3TOTAL S ; SUBTOTAL S ; <br /> PEFIMIT S i PERMIT 5 i <br /> TOTAL FEE 5 � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT$ETBACK REM SET�A:H SIOE SETB�CN PIAN CIIECK NUMOER FEE qECEIPT N0. <br /> y���'O <br /> uSEzo�+e LOTAREP VAC�NTSITE FEES VALUATION FEE <br /> -T <br /> f7 YES ❑ NO B111L�ING � <br /> HEIGNT UMITATIOk NO.OF OWELLING SIZE OF BLOGR.I. <br /> UNIiS PLUMBING i <br /> � <br /> OCGIIPANCV NOOFSTOPIES OCCl1PSNTLOAD BASEMENT � <br /> GROUP MECHANICAL � <br /> fl YE5 ❑ NO � <br /> �� , <br /> FIREALARMREO'D REASON ADDITIONFLPLANCH6CK � � <br /> i-- <br /> � ' <br /> FlRESPRINKLERFEOD REASCN nTf1ER �`)�.��/ '�(/J L�� � � <br /> i � <br /> ^TATE BUILDINC SURCHARGE i <br /> TYPEOF WNST. PLANSA�{'PROVEDBY CITY OF EVERETT PUBtIC WORKS � <br /> VM / LOCALSALES � <br /> __ onTe I Z' �C TAX CODE IS 3105 70TAL �p0 I — <br /> ,_ <br /> .. - —. ----___ .._..._ .. �_ <br />