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.-, - <br /> APPLICATION FOR CONSTRUCTIt�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> fl DEMOLITION fl COMBINATION fl BUILDING fl MECHANICAL �l PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> ,Z// 7 o/¢KES �4 Ut. c d't�T� <br /> OWNER MRILADDRESS Cltt ZIP PNON[ <br /> ,Ye�+.f.�� r. atx� .s.�. S�,�s`�.�.re�r- p�zo� (ze`� Zss -� �ss . <br /> TENANT MAILAD�RESS CITV 21P PHONE <br /> f/�'l�t <br /> ARCHITECTORDESiGtlEB MRILAUORE55 Cltt Z�P PIIONE <br /> GENERALCONTMCTOR MAILA�DRE55 GIiY Z�P PIIO4E STATEIICFNSE� <br /> 56'Z"F _ <br /> MECHANILALCONTRACTOP MAIIADDRE55 CITV 21P PIIONE STATELICENSE� <br /> PLUMBINGCONiRRCTOR MAILAO�RE55 Cltt ZIP PHONE ST�IEUCENSE� <br /> GONTRACT PRICE Of WORN <br /> HEATING SYSTEM: f 1 GAS f7 ELECTRIC �l <br /> DESCRIBE WORK AN�SOIIRRE FOOTAGE INVOWEO CONTACT PERSON AND PNONF NO. <br /> .�E�+�rivk �E'�seF o? Sc <br /> I HEREBV CERTIFY THAT I HAVE READ AND E%AMiNED THIS <br /> APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br /> PROPOSED VSE OF BIIIiDING PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF , <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�LDESCRIPTIIXJOFPROPERiY�SHONN6ELOWORATTALHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot PLOCN oF AUTHORITY 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%1 NUMBER CONTRACTORS LAW 10.27 RCW AND 296200 WAC. <br /> .3� - �3�- oC�� dcz> !— � �/j�� <br /> CONSTFiUCT10N IO�N LENOER.AODRESS,7ELEPXONE NUMBER X �ML ��(lll�ja �• ��� 7� 7 �� <br /> SIGN TURE DATE <br /> CITY BUSINE55 LICENSE NO. <br /> PLUMBINd MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. 7YPE OF EQUIPMENT FEE <br /> � WATERCLOSET�TOILET) � A/C—AMNULGUNITS—H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; � <br /> LAVATORV(WASH BASIN) � HEAT PUMP � _ <br /> SHOWER � UNITHEATEFiS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAY i RANGE HOOD i <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> ORINKING FOUNTAIN � METAL FIREPIACE�WOOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> DACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE ' <br /> GAS PIPING <br /> EXHAUST FAN � <br /> � ' <br /> i ' <br /> � ' <br /> � ' <br /> � ' <br /> SUBTOTAL 5 ' SUBTOTAL S i <br /> i <br /> PERMIT $ i PERMIT S � <br /> TOTAL FEE $ � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSF.iPACK RERRSF.TBACK SIDESETBACN PlANC11ECKNUMACR PEE R[f.EIPiNO. <br /> �va�� <br /> usezor+e IOTAREA VnLANtSITE FEES VALUATION FEE <br /> f1YE5 I1N0 �/ � i � <br /> 13UILDMG �� O � <br /> IIEIGHTIIMITATION NOOFDWEL�ING SIZEOFBLOGRI <br /> UNIfS P�UMAMC <br /> � <br /> OCGIIPRNCV NO Of StOmES OCWPANT LOAD BASEMENT � <br /> GROUP MGCIIPNIf,AL � _ <br /> I1VE5 I-i NO <br /> FlRE�URMREO�D PE�SOY PDDIiION/.LPLANC��f.CK � <br /> ---i— <br /> i <br /> on�cn I <br /> FIRF.SPRINKIF.RPEOD RF�AON � <br /> Sin1E OIIILUING SU11C11MGE � <br /> ;SJ <br /> rvreorr.or+sr ri.nr+snrvnovEoor CITYOFEVERETT nunncwonKs <br /> LOCAL SMLES — <br /> �A�E TAX CODE IS 3105 707AL �I��� <br />