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APPLICATIt�+V FOR CONSTRUCI .ON PERMIT <br /> _ CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOUTION fl COMBINATION f�+�BUILDING f� MECHANICAL f� PLUMBING fl SIGN <br /> PROJECT ADDRESS -r <br /> � iv/ � � �n �/c�c'�� <br /> OWNER MFILAD fiESS (,ITY ZIP �'NONE <br /> Q�4L� c,CJ�CILr�t 7I��O`YW�C /JiTC��CnCc7T Q/�i.20� �5 5- 3 y��' <br /> TENANT MlILADDPF55 CItV ZIP PIIONE <br /> ARCHITF.CTORUES'3NER MAILAUORESS Cltt Z�P PMONE <br /> o�G l�u/ �c=�'�6/� ���`"�� G <br /> GENEBALCONTRRCT MAILApORB45 CIiV 7.IP PHpY[ STATELICENSE� <br /> ��L � <br /> MECHANICA�CONTRACTOP MAILAODRESS CITY .'��' PI�ONE STATELICENSE� <br /> ��d,�/c.-' <br /> PLUMBINGCONiRACTOR MAILA�ORESS QiV D^ PHONE STATELICENSE� <br /> O � <br /> WNTRRCT P ICE OF WORN /� <br /> � O6CJ, CJ G �2��/� HEATING SYSTEM: f7 GAS fl ELECTRIC ❑ <br /> DESCRI N AND SOURRE FOOTAGE INVOLVE� [ON7AC�t PEPSON AND PIIONE N0. <br /> +'C r G <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED TH�S <br /> PROPOSED USE OF/�UILOING ' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> \ '1/�VZ IC ��y)L.� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGRLDESC�RI"t(IONOFPROPERTY�SNOWNPELOWOR TTACMTWOCOPI NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor_l�_e�ocK�oF `� l( AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �/(J -7' 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 /> PARCE�T�E I.O.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �. . —r .L ��4� /������1�—� <br /> GONSTRUCTION LOAN L[NOER.AD�RE55.TEIEPHONE NUMBER x <br /> SIGN URE DATE <br /> � CITYBUSINESSLICENSHNO. <br /> PLUMBING MECHANiCAL <br /> NO. TYPE OF Fl%TURE OR ITEM FEE TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—MiNDLG UNITS—H.P. ' <br /> BATHTUB � ORCEDA�RSYSTEMS—B.T.U. M E.A. ' <br /> i <br /> LAVATORV(WASH BASIN) , T PUMP � <br /> SHOWER � UNI EATERS—B.T.U. M ' <br /> TCHEN SINK&DISP ; CLOT S DRYEFS i <br /> DI WASHER VENTILA N FAN � <br /> lAU RY TRAY ; RANGE HO � <br /> CLOTH WASHER � WATER HEAT � <br /> URINAL WOOD STOVE ' <br /> DRINKING FO TAIN ; METAL FIREPLACE OOD BURNING) � <br /> FLOOR DRAIN � FIREPLACE INSERT( OD BURNING) ' <br /> BACKFLOW PREV TERS ; GAS FIREPIACE � <br /> SINK(SERVICE—BA ETC.) GAS RANGE <br /> GAS PIPING ' <br /> ; EXHAUSTFAN � <br /> � ' <br /> � � <br /> � <br /> � ' <br /> SUB TOTAL 5 ' SUB TOTAL $ i <br /> � <br /> PERMIT S � PERMIT $ � <br /> TOTALFEE $ � TOTAIFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> PRONT SETBACN qEAR SETOA.C�JN ��''5 SI�E SET�AC/\K / PLnN GIIEC N M�GR F[E .{9���J RECEIPT N0. <br /> ✓ � � lil../ � V !� . / /� � /�! � � <br /> usEzoNe �oTnneR vncnNtsne FEES VALUATION FEE <br /> I�YES C1 N� Ol➢LDIN� '� '� L iD� <br /> HEIGHT LIMITATICN NO OF DWELLING 512L OF BLOGRA � <br /> �7 / I UNITS �i�U S GA��" P�UM�I4G _� <br /> .r , � � <br /> OCGUPANCV NO Of Si0RIE5 OCCIIPANT LOAO , BASEMENT MEGHANICAL � <br /> GROUP <br /> -� N n �Y�S a � <br /> FlR[AURM REO'� REASON P�OITIONAI PIAN GHECK I <br /> � � <br /> OTHER i <br /> FlRESPRINKIERREO'D RF�SON � <br /> (�� STGTE�UILDING SU(iCM4RGE i< � <br /> /Y 'J• <br /> TYPEOFCON57' PLANSPP�fi VEq OY CITYOFEVERETT �UOIICWORKS i <br /> �a LOCAL SALES ' <br /> -/J onTe l3/SS TAX CODE IS 3105 TOTAL ��� <br />