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APPLICATI�,.d FOR CONSTRUCI �0�� PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION f 1 COMBINATION f-1 BUILDING MECHANICAL fl PLUMBING f-1 SIGN <br /> PROJECT ADDRESS J D ! G DA� K�S � f/F-, F✓r�� TT <br /> / <br /> OWNER MAILADDRE55 CITV 21P PHONE <br /> ��O�CjF_ �AVNS�CtQ� /03� D.}/�Ef /}yE �YE���' W-� �S2oJ `Z' S$-6 /S3 <br /> iENANT MRILAODRE55 CI1Y 71P �HONE <br /> ARCHITECTORDESIGNER MAILADORE55 QTV ZIP PHONE <br /> GENEP�L CONTRACTOR MAIL ADURESS GITY ZIP PHONE SiATE LICENSE t <br /> MECHANICRLCONTR�CTOR MAILADDRE55 CITY ZIP PHONE STATELICENSE� <br /> PLUMBINGCONTRACTOR MAILADDRE55 CITV ZIP PHONE SiATELICENSE� <br /> CONTRACT PRICE OF WORN <br /> HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AND SOUARE FOOT�GE INVOLVED CONTACT PERSON AND PHONE NO. <br /> 00o v F a,w . <br /> �a-�d ' �.�C a.v,, Dv� s <br /> ����/� �DUO, °I HEREBY CERTIFV THAT I F ' �_ �D AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE S� _ BE TRUE AND CORRECT.ALL <br /> �f j� �.N�t PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWOflPTTRCHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK oF AUTHORITV 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.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,AD�RE55.TEIEPMONE NUMBER X / '� FJIf' /. �/7 <br /> 51 RTURE DATE <br /> CITV BUSINESS UCENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—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&DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS i GAS FIREPLACE i <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> ' GAS PIPING ' <br /> ; EXHAUST FAN � <br /> i � <br /> � � <br /> i � <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAL $ ; � <br /> PERMIT S i PERMIT $ / � � <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SEiAACK RERR SETBACN SIDE SETOACK Pll�N CIIECK NUMOER_/� FEE RECEIPT NO. <br /> /_/I <br /> (L'% <br /> USEZONE LOTRREA VACANi51TE FEES VALUATION FEE <br /> fl YES fl NO � <br /> 011Il01NC � <br /> MEIGHTLIMITATION NO.OFDWE�LING SIZEOF�IDGRI. � <br /> UNITS PllIM01NG � <br /> OCCUPANCY NO OFSIORIES OCCUPANTLORO BRSEMENT MECMANICAL j <br /> GPOUP <br /> ❑YES Il NO � <br /> ADUITIONAI PIAN CHECK i <br /> FIREALARMREO'0 �EASON � <br /> i <br /> OTHER � <br /> FIRE SPRINKLER REO'0 REASON � <br /> STATE OUILDMG SURCHAPGE � <br /> TVPEOPCONST PIANSPPPROVEDBY CITYOFEVERETT �UB�ICWORKS j <br /> LOCAL SALES � <br /> onre TAX CODE IS 3105 TOTAL � <br />