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� <br /> . .-. <br /> APPLICATI�,.d FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, \`IA 98201 •259-8810 <br /> i7 DEMOUTION C] COMBINATION ❑ BUILD{NG fJ�MECHANICAL �LUMBING Cl SIGN <br /> PROJECT ADDRESS <br /> � <br /> OVMER MAILAQORE PHONE <br /> _ �i�GZT' I�An� a�tl�F•�- I�Ci�l,2a � ►Z�P � �✓���� �_ _ S���cl <br /> TENANT M�I DD ESS P ONE <br /> ��� .�� I�A-n� aTf,v ia��3 ��?�E.�� _ <br /> ARCNITECTOR�ESIGNER M�ILAD�RESS CIN 71P PHONE <br /> �EW4CONTRACTOR MMLAOORESS � Cltt ZIP PHONE STATELICENSE� <br /> �ll Lt1�i��C.(-{c�i =�.. �X�n I 1�€�,�.�Il��kc S'i� �ll�' ��'S/?7��� ' � <br /> MECHAN��ACTOR M�IL 1DDRE55 CITY ZIP PHONE STATE LIC �/D� �� <br /> C <br /> PLU INOCONTR�OR MAILAUDRE55 CItY ZIP PHONE STATELICENSE� <br /> CON C PR�CE OF WOPK <br /> � HEATING SYSTEM: ,P_'�GAS ❑ ELECTRIC ❑ <br /> DESCRIB �K AND SOUA�FOOTAOE INVOL D GONTAC ERSON AN PHpNE NO. <br /> � ,(� .� � � i � — <br /> � ' � <br /> � , I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT.ALL <br /> seo u oc euuawo PROVISIONS OF LAWS AND ORDINANCES GOVERNINp THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LCiL1lUESCPIPTIONOFPRpPERTY(SMOWNBELOWORAR�CNTWOCOPIES) NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> � ior eioac oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOULATINd CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY�HE <br /> OWNER OF THIS PROPERTY TO P RFORM THE WORK WR WHICH <br /> APPLICATION I MADE AN COMPLV WITH THE STATE <br /> PARCELTN!LD.NUMBER CONTRA 5 LA 1827 R D 296200 WAC. <br /> CONS7RUCTON LOAN LENOER.�DOHESS,7ELEPlqNE NUMBER x � � � <br /> SION� RE �� <br /> CITY BUSINE55 LICENSE NO. <br /> P�UMBINO MECNANICAL <br /> NO. TYPE OF FlXTURE OR REM FEE NO. TYPE OF Fl%TURE OR ITEM FEE <br /> WATER CLOSET(TOILEn � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEM .T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RAN6E HOOD ' <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE � <br /> DRINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINO) � <br /> BACKFLOW PpEVENTERS ; OAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � OAS RANGE � <br /> ' OAS PIPING ' <br /> � ExHAUST FAN � <br /> � , <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S � SUB TOTAL 5 � <br /> PERMIT S i PERMIT S i <br /> TOTAIFEE S ' TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SEfBACK SIDE SETB�CK PUN CHEC UMBER fE@ RECEIPT NO. <br /> �3i � <br /> use zor+e tor�q� VACANT SITE FEES VALUATION FEE <br /> ❑ves ❑ r+o euaoiNc � <br /> � <br /> HEIOHTLIMIT�TION NO.OFDWELLING SIZEOFBIDCaRI. � <br /> UNITS PLUMBING i <br /> OCCUPANCY NO OG STOfAES OCCUPANT LO�D BRSEMENT MECH�NICRL i <br /> 6ROUP <br /> ❑YES Il NO i <br /> FIPEIIURMREO'D REASON ADDI710NRLPlAyCNECK i <br /> OTHER i <br /> FIRE SVRINI(LER REO'D REASON <br /> i <br /> STATE B�IIDING SURCHARGE � <br /> TYPE OF CONST PUNS APPROVED BY CITY OF EVERETT PUBLIC WpRKS � <br /> LOCAL SALES ; <br /> o�� TAX CODE IS 3105 70TAL I <br />