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� <br /> ARPLICATIi. .� FOF� COI�STRUC7 .ON PERM1�' <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION G� COMBINi1TION ❑ BUILDING ❑ n7ECHANICAL ❑ F'LUMBING C SIGN <br /> PROJ CT ALIDRESS <br /> -�a � R' L.n .m/�,�rc�. <br /> o p MAILADDRESS c.n zm PHONE 3s3 �iy� <br /> �n� L'2ass l I ia �! ao�`L' Sf 5 ,�. ,rU�P�-� 8'aos s3 ,% y��� _ <br /> T ANT MAILAU�RE55 CITY ZIP oHONE <br /> ARLHITECT OP DESI3NEH MAILAO�flE55 qTV ZIP PNONE <br /> �ENERALCONTRACTOR �n MAILF�DRESS CIrY ZIP PHONE STATELICENSE� <br /> ����` <br /> NECHAMCALCONTRACTOH MAILADDRESS CIN ZIP PHONE S7ATELICENSE� <br /> PLUN�01 CJ CTOR IAAIL�q'DDRE �� n PHONE STATE LICENSE Y <br /> l � J vllfl l/J 1�/�/�tl' �� � <br /> �� � � <br /> CON RA PPoCE OF WOFK <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑_ <br /> DESCRIBEWC9KA DSOUA FOOTAGEIN/V�OLVED �,� CONTACTPERSONANOPHONENO. <br /> '� C.5 'Q � <br /> �ra�� ar� - — <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROPOSED USE OF BUILOINQ pROVISIONS OF LAVJS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH YVHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPFOPERTYISHOWNPELUWOAATTACHTWOCOPIES) NOT. THE GRAN-�ING OP A PERMIT DOES NOT PRESUME TO GIVE <br /> �or 9LOCK oF AUThiOHITY TO VIOLATE GR CAItlCEL THF PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING G'�NSTRUCTION OR THE <br /> PERFOPMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEH OF THIS ?ROPERTY TO PERFORM THE WORK FOR WHICfI <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR TORS LAW 18.27 RCW AND 296200 WAC. <br /> PqRCF,LTA%I.D.NUMBER _ <br /> /�3� - 7l0 -C% GY�t23 <br /> CONSiRUCTION LOAN LENDER,ADDRE^u5.TEL'_PHONE P'UMBEN � � �` � <br /> IG A RE DATE <br /> CITY BUS ESS�ICENSE NO. <br /> PLUMBING MF.CHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM FEE N0. TYPE OF PIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A!C—AMNULG UNITS—H.P. ' <br /> BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> T <br /> LAVATORY(WASH BASIN) i HEAT PUMP ' <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> ' CLOTHES DRYEFS � <br /> KITCHEN SINK 3 DISP � <br /> DISHWASHER � VENTILATION FAN �_ <br /> � LAUNDRY TRAY ; RANGE H000 � <br /> CLOTHES WASHER � WATER HEATER ' <br /> URINAL ' WOOD STOVE � � <br /> DRINKING FOUNTAIN ' METAL FIREPLACE(WOOD BURNING) � <br /> i —.— <br /> FLOOR DRAIN ' � ! FIREPIACE INSCRT(WOOD BURNING) ' <br /> i <br /> BACKFLOW PFEVENTERS ; GAS FIR=PLACE � <br /> SINK(SERVICE—BAR,ETC.) i GAS RANGE ' <br /> � GAS PIPING <br /> � EXHAUST FAN ' _ <br /> i � <br /> i � <br /> i — <br /> - � � — <br /> SUB TOTAL $ i SUB TOTAL $ ' <br /> � <br /> � PERM:T S i PERMIT $ � <br /> TOTAL FEE $ � TOTAL FEE $� ' <br /> F'OR CFFICH USE ONLY: <br /> FfiONT SETBACK REAR SETBACK SI�E SETDACK PLAN CHEC NUMBE/R7 FEE�/� �"' AECEIPT NO. <br /> ,J'/ / <br /> usEzor+e LOTAREA VACAN�SIIE FEE VALUA710N FEE <br /> ❑VES ❑ NO BUILDING �'vyD r � � � <br /> HEIGHT LIMITAT7CN NO.OF UWELLING SIZE OF BLDGRI. � <br /> UNITS r' PL11M81NG <br /> i <br /> ✓ i <br /> OCCUP CY NO-0FS O�IES OCCUPAN LQBD BASEMEN7 MECHANICPL i <br /> GROUP � � `� ❑YES ❑ NO � <br /> i <br /> pD�IT10NAl P V N CHEGK � <br /> � <br /> FIRE FM REO'D REA O <br /> i <br /> OTNER � <br /> � <br /> FIFE SPRINGLER GEO'D PEASO"1 . STATE BUILDING SUHCHAflGE � j Y'. '�. <br /> �..yti ._ <br /> i <br /> TYPEOFCONST. PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS i <br /> �j p 4.� r �� LOCAL SALES �.- � �Q <br /> oATE � � � . TAX COD[IS 3105 TOTAL <br /> � � . <br />