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APPLlCATIOrI FOR CONSTRUCT �ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHAMCAL ❑ PWMBING (l SIGN <br /> PROJECT AD RESS / <br /> o� .�Ui''1 Cc/' �o <br /> OWNER MAILAOOPE55 CITV 21P PHONE <br /> Ca�,�,��GL , �SS /��-l�mB?�fJC� ��/ /��o/ �0 3 -�'3 �a <br /> TENAN7 ^ /j� � MAILA�DRESS CIT'! 21P PHONE <br /> : //'� � <br /> ARCHITFCTOR�ESIGNER MFILAODFE55 CITY ZIP PHONE <br /> GENERALGONTRACTOR ALA�ORESS CITV 21P PHONE SiATELICENSE• <br /> ��� l,✓FtT���c�Tc/� � �� �%�n�'-st//��kc- �',� 9�Yi�yaB�y�o�,�/�r.-lwHia,�,,ea <br /> CHANICAL CONTRACTOR MAIL ADDRE55 CI ZIP PHONE STATE LICcNSE b <br /> PLUhIBINGCONTRACTOR MAIL40DRE55 Cltt ZIP PHONE STAT[LICENSE� <br /> CONTRqCTPflICEOFWORK HEATING SYSTEM: GAS O ELECTRIC ❑ <br /> DESCRIBE WORKAND SOUARE FOOT GE IN OLVED CONTACT PEHSON AND PMONE NO. <br /> �t7s � �= � t <br /> Y� € U'��/9CE / <br /> I HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO VSE OF tlUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WOP.K WILL BE COMPLIED WITH WHETHER SPECIFIED HEFEIN OR <br /> LEGALDESCRIPTIONOFPROPERNISHOWNBELOWORA7TACHTWOGOPIESI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e oF _ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINC CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY T � ERFORM THE WORK FOR WHICH <br /> APPLICATION I ADE � I COMPLY WITH THE STATE <br /> PPRCEL TAJc I.D.NUMBER CONTRACTO AW 102 �VJ AND 29620�pIAC. <br /> � - V rrr��� �. <br /> CONSTRUCTION;'4N LENOER,AD�FE55,iELE?HONE NUMDER X ��, <br /> SIGNFTUPF. 1E <br /> CIiV�USINESS LICENSE N0. <br /> PLUMBING MEC HANICAL <br /> NO. TVPE OF FI%TURE OR ITEM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSI'EMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i HEP.T PUMP � <br /> SHpWER � UNIT HEATERS—B.T.U. M - � — ' <br /> KITCHEN SINK&DISP ; CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDHY TRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKING FOUNTAIN ; h1ETAL FIREFLACE(WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT('NOOD BURNING) ' <br /> BACKFLOW PREVENTERS � GASFIREPLACE i <br /> SINK(SERVICE—BAR, ETC.) GAS RANGE � <br /> GAS PIPING —p % ' <br /> � EXHAUST FAN � <br /> i ' <br /> SUB TOTAL 3 ; SUB TOTAL 5 ; <br /> PERMIT $ � PERMIT 5 �S � <br /> TOTAL FEE $ � TOTAL FEE S �� ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK S�DE SF.TDACK PLAN CHEC� ER FEE RECEIPT NO. <br /> usezoNe �oraaen VACANTSITE FEES VALUATION FEE <br /> � <br /> fl YES ❑ NO OUILDING � <br /> HEIGHTLIMITFTION NO.OfOWGWNG SREOFBLOG/TI. � <br /> UNITS pWMpING � <br /> O"CUPANCV NO OFSTORIES OCCUPANiLOAD BASEMEHT MECH�NICAL � <br /> GROUP <br /> ❑YES ❑ NO � <br /> FIflEAIAqMREO'D REASON AODRIONPLPLANCMECN I <br /> i <br /> O7HEF � <br /> FIRE SPRINKLER REO'D REASON � <br /> STATE BUILOING Sl1RCH�RGE � <br /> TYPEOFCONS�-. PLANSAPPROVEDOV CITYOFEVERETT PU�LICWORKS � <br /> LOCAL SALES � <br /> D.`.?E TAX CODE IS 3105 TOTAL � <br />