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APPLICAT11.d FOR CONSTRUCI .ON PERMIT <br /> CITY UF EVERETT• BUILDING DIVISION � <br /> 320U CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> O DEMOUTION Cl COMBINATION � BUILDING ❑ MECHANICAL fl PLUMBING fl SIGN <br /> PR JE T ADDRESS <br /> IhOVI �b 00 rOl�o BG �YP. 91'L <br /> ONTlER _, � y.�_� {` �� IA, � W-IL �Nv11 RZVVV7 %%�N`��}(/V{/' <br /> i�u��I vl�i � <br /> TEN�NT �/ MAILADDR[SS QTV 2iP PIIONE <br /> � P7 K��� <br /> ARCHITEC OROE51 NER M ILADDRE55 Cltt 7.IP PHONE <br /> Fir►�-u� r�1' I�12 i� �1tPX'e1r' �4�201 ?x�6�'I► �-N�r�l•�o42 <br /> GENERALC�Oy• pCTOR MRILAUDRE55 CItY 21P PHONE STATELICENSE� <br /> O�IIC11 <br /> NECHANICALCONTRACTOR MAILADDRE55 CIN ZIP PIIONE STATEUCENSE� <br /> Nk. <br /> PWMBINGCONiRRCTOR MAILADDRE55 CITY 21P PNONE STATEUCENSE• <br /> �• <br /> �NTRACT P E OF WORK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> D�1 VIORK ND SOUARE FQO �GE INVOLVEO n CONTACT PER N AND P NE <br /> L � V <br /> �j jlpy► i <br /> i I HEREBY CER�fIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COfiRECT.AlL <br /> PROPOSE u F B ort PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> G WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lEG LDES RIPTIONOFPROPERTY(SMOWNBELOWORATTACHTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT BLOCN oF AU�HOR�TY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �,� � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.D.N eEA CONTRACTORS LAW 1827 C I AND 296200 WAC. <br /> a 3 oaQ � 9 <br /> CONSTRUC710N LOAN LENOER,ADDRE55.TELEPMONE NUNBER X <br /> 51 N R QI�M DAT <br /> f�.` <br /> CIiV BUSINESS LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILEn � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK&DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERVICE—BAR, ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> i EXHAUSTFAN � <br /> � ' <br /> � � <br /> � <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAI 5 i <br /> PERMIT 5 � PERMIT $ � <br /> TOTALFEE 5 ' TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSET�ACK SI�ESETBRCR PLANCHECNNUUD@fl FEE RECEIPTNO. <br /> ad <br /> USE20NE e � � IOTAiiEA VACANTSITE FEES VALUATION FEE _ <br /> ` flVES fl NO ��—_– <br /> 9UILDING i <br /> MEIGNTLIMITATION NO.OFUWELLING SREOFOLOGRI. � <br /> UMITS /� PlUM01NG � <br /> OCCUPANCV NO OFSTORIES OCCUPANTLOAD PRSEMENi MECMnNICRL � <br /> GROUP <br /> ❑YES 6�'NO i <br /> FIREALARMREO'0 REASON ADDITIONAIPLANCHECK � _ <br /> AID � <br /> OTNER i <br /> FlRE SPRINKLER PEO'0 PEFSON i <br /> y0 �/ STATE OUILDING SUACHARGE iA/1 <br /> N �� � <br /> TYPEOFCONST PLAN FPP V OBY CITYOFEVERETT Pl1�LICWORKS � <br /> Ti r / LOCAL SALES — �n <br /> ���V onre /� TAX CODE IS 3105 70TAL L <br />