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APPLICATIG.� FOR CONSTRUCT.ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETf, WA 98201 •259-8810 <br /> ❑ DEMOLITION fl COMBINATION fl BUILpING fl MECHANICAL I� PLUMBING ❑ SIGN <br /> PROJECT ADDRESS Z�ZS pJ-��L S <br /> OWNEii M�AII�pURE55 <dtt a` p`1P vCa.� `A� 1"'o.�IS �J'} �OL1 ���'J��f <br /> S�-� �av„ L. W� n1E�-oi-K Ibbo, 11� N1� <br /> TENANi A�AILAODRESS CITV ZIP PMONE <br /> ARCHITECTOROESIGNER MAILAOORE55 CIN ]IP PMONE <br /> J�,p���RRl CO^NTlpAC,TOR MAILAOORE55 LITV ZIP PMONE STA�E LICENSE r <br /> / /��✓ <br /> ECHRNICALCONTAACTOR MAILADDPESS CITV ZIP PNONE STATEUCENSE/ <br /> PLUMBING CONTRACTOR MRILAODRESS Cltt 21P PHONE STATE IICENSE� <br /> CONTRACT PRICE OF WORK <br /> � � y'O O HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCfiIB WORK AND SOURRE F T� E INVOLVEO ,[' ` CONTP�PERSON PN�PMONE Np <br /> Wn � 1h • 1'00`1`� _ <br /> 1�7�. Tw � 5 Q.i' <br /> �T2�co o.-..., S�1 J� 42 0�+... ?LW�v�'tl. APPL CAT ON AND KNOW THE SAME TO BE�TRUE A DXCORR CT.ALL <br /> PROPOSED USE OF BUILOING y PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> h � t'C5 J�w+[. WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESC IPTIONOFPROPERTY�SNOWNBELOWORATfACNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor _etocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF COVSTRUCTIOY.THAT I AI,A AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> \ / � <br /> CANSTRUCTION LO�N LENDER.PDDRESS,TELEPHONE NUMBER � �.. ,n-an� <br /> NATURE DATE <br /> CIN BUSINESS LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIIITURE OR ITEM FEE NO. TYPE OF FlXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � NC—PJHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP T_ <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD i <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 ; GASFIREPLACE i <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING ' <br /> � ExHAUST FAN � <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> PERMIT $ i PERMIT 5 � <br /> TOTAL FEE $ � TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK AEAR SETOACK SI�E SETOACK PLAN CNECN NUMDER FEE RELEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> (1 YES fl NO pUIL01NG � <br /> i <br /> HEIGHTUMITATON NOOFDWELLING SIZEOFBLOGRI. i <br /> UNITS PLUM�ING � <br /> OCCUPANCY NOAFSTOPIES OCCUPANTLOAD BASEMENT MECHANICAL � <br /> GROUP <br /> ❑YES ll NO i <br /> FIRE AURN REO'0 REASON A�DITIONAL PLAN CMGCK � <br /> i <br /> OTMEF j <br /> FIRE SPRINKLER REO'D REASON � <br /> STATE OUILDING SURCHARGE �� <br /> TVPEOFCONST. PIANSAPPPOVEDOY CITYOFEVEREIT P�PUCWORNS j <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 TOTAL � —' <br />