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APPLiCAT10N FOR CONSTRUCT�JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION I�COMBINATION � BUILDING p� MECHANICAL 4�LPLUMBING Cl SIGN <br /> PROJECT ADDRESS '�,L "� <br /> / iy J <br /> O/W,NER �''AILAODRE55 Citt ZIP PNONE <br /> y��ir.EE✓� �/O/,l.✓SO.(/ �7�� J�/A�,E Z.S9- '��,79 <br /> TENRNT MAILA�DRESS CI7Y ZIP PHONE <br /> ����_� <br /> ARCMITECTORDE IGNER MAILADURESS Cltt ZIP PMONE <br /> ENEHALCONTP�CTOR MAILRDORESS CITY ZIP PNO � SUTELICENSE� <br /> G—l'�i/Si,caf�-,—���ri /.�1iz �'�.t/r l l ����' _�/ !���.r � �G�,i+Fw. <br /> MECHANICAICONTAACTOR MtiILADURESS CITY ZIP HONE STATE4CENSE� <br /> PLUMBING CONTRACTOR M4'�qppRE55 CI7Y 21P PHONE STATE IICENSE� <br /> s� S' . <br /> CONTRACT PRICE OF WORN <br /> �,d-c HEATING SYSTEM: L7 GAS ❑ELECTRIC RL <br /> UE I WORKANDSOUAREFOOT INVOlVEO CONTACTPERSONANDPHONENO. <br /> ��,�a�,��. �t;, .- � <br /> , <br /> �Ls I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raoroSr�yuse�evaon+c APPLICATION AND KNOW THE SAME TO BE TqUE AND COFRECT.ALL <br /> ��� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGAL�ESCRIPTIONOFPROPERTY�SFqWNBELOWOR�TTACHTWOCOPI 5) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�_e�ocK�oF� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> '" T � �C PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �` /0�..������C ��A •�N APPLICATIO IS MADE I COMPLY WITH THE STATE <br /> PM.CELTA%I.D. NMBER CONTRAC O S LAW 18. CW/AND 296200 WAC. <br /> CONSTHUCTION LOAN IENUER,ADDRESS,7ELEPMONE NUMBER ,��� �� - ,� <br /> X <br /> SIG AT E DI1TE <br /> CITV BUSINESS LICENSE N0. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF FlXTURE OR REM FEE <br /> _L WATERCLOSET(TOILEn � A!C—AMNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> / LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKIN6 FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> �— <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> ' GAS PIPING ' <br /> � EXHAUSTFAN / � <br /> � � <br /> � � <br /> i � <br /> � � <br /> SUB TOTAL S � SUB TOTAL S ' <br /> � <br /> PERMIT $ � PERMIT 5 � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBALK REAq SETBRCK SIDE SETB�CK PLAN CHECK NUMBER n FEE PECEIPT NO. <br /> Nu%'-i 7` <br /> usezor+e LOTAREA VRCANTSITE FEES VALUATON FEE <br /> ❑YES ❑ NO BUILDING ��� <br /> HEIGHTLIMITATION NOOFOWEILING 512EOFBLDG?�. � <br /> UNIT$ P�UMBING � <br /> GROUP�NCV NOOL'Si0RIE5 OCCUPANTLOAD B�SEMENT MECNANICAI � <br /> C1YE5 ❑ NO � <br /> FIRE�URMREO'D q[p50N ADDITIONALPLANCNECN I <br /> OTHER � <br /> � <br /> FIRE SPRINKLFR REO'D REASON � <br /> STATE BUILOING SURCH�AGE � <br /> TYPEOFCONST PLANSPPPROVEDBY CRYOFEVERE7T PUBLICWORKS j � <br /> LOCAL SALES � <br /> oATE TAX CODE IS 3105 TO7AL � � <br />