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-� <br /> APPLICATI(..�1 FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8910 <br /> DEMOLITION rl COMBINATION fl BUILDING fl MECHANICAL fl PLUMBING fl SIGN <br /> P JECT P')D SS <br /> . �,� � o � � ,� � i .3 �i a � �/ <br /> OWNER tdA�LAO�RE�j � Cltt Zln PNONE <br /> !P �. d'd�S /n-2_ .S� - <br /> TENpN MAIL�OORE55 CIIV 21P FHONE <br /> ARCHITECTORDESIGNEH MAILAD�RESS Qtt ZIP PMONE <br /> GEN ICONTRACTOR MAILAUDRE55 CITY ZIP PIIOYE STATELICENSE/ <br /> ��)/W V <br /> MECHANICALCONTRACTOR MAILpDORE55 CITV ZIP PIIONE STATEIICENSE� <br /> PLUMBING CONTRACTOR MAIL ADORE55 Citt ZIP PNONE STAiE LICENSE Y <br /> CONTRACi PRICE OF WORK <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC fl <br /> OESCRIBEWORKANDSOUAREFOOTRGEINVOLVEO LON PERSONANOpI NENO. �/� 3 _,,,73 �i <br /> � %T,� <br /> I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br /> PAOPoSED USE OF BUII.DINC. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF . <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �Q �LpE�SC�iI?T�OFPROPERTV�SG��tIOWORATf��coa � / NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Y8r G��� ocK�.1�oF �U��Q' AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> , /, �J OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> "�z PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> /' �I OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �7 3 ~ �S� D / — DO D O APPLICATION IS MADE AND i COMPLY WITH THE STATE <br /> PRRCELTA%I.D.NUMBER CONTRA TORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTIONLO�NLENDER.POURESS.TELEPMONENUMBER x G��I1�0 W�`�liG/� � � � O� I I� <br /> SIGNATIIRE OATE <br /> CITY BUSINE55 LICENSE NO. <br /> . PLUMBINO MECHANICAL <br /> NO. TYPE OF FIIfTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> , WATER CLOSET(TOILET) � A/C—AIIiNDLG UNITS—H.P. � <br /> BATHTUB � FORCED AIR SYSTEAIS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) i HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES ORYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RA�GE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSEFT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS i GAS FIREPLACE i <br /> SINK(SERVICE—�AR,ETC.) � GAS RANGE � <br /> � GAS PIPING ' <br /> i EXHAUSTFAN i <br /> i � <br /> i � <br /> � � <br /> � i <br /> SUB TOTAL 5 ; SUB TOTAL S ; <br /> PERM�T 5 i PERMIT S � <br /> TOTALFEE 5 ' TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN RE�R SETUALK SIOE SET�RCK PIAN C 1 K NUU� PEE RECEIPT NO. <br /> 'f0� <br /> USEZONE LOTAPEA VRCANTSITE FEES VALUATION FEE <br /> fIYES fl NO OUILDING � <br /> HEIGMT LIMITFTION NO.OF D1YE�LING SIZE OP BLOGR.I. <br /> VNITS PLUlAOMG i <br /> OCCUPANCY NOOLSi0RiE5 OCCIIPANTLOAD BASEMENT MECNANICAL � <br /> CROUP � <br /> ❑YE$ fl NO i <br /> ADDITIONAL PIAN CHECK i <br /> FIREALARMREO'D REASON i <br /> OTMER � <br /> i <br /> FIPE SPRINNLER REO'0 REASON i <br /> S7ATE OUILDING SIIRCN�BGE i <br /> TVPEOFCONST PLl�NSAPPROVEDOY CITYOFEVERE7T Pl1f1LICWORKS � <br /> LOCAL SALES � <br /> o,�re TAX CODE IS 3105 TOTAL I <br />