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APPLICATIG.� FOR CONSTRUC7 JN PERMIT/ <br /> CITY OF EVERETT• BUILDING DIVISION L�C�!�� <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•8810 � <br /> ❑ DEM�UTION fl COMBINATION fl BUILDING r7 MECHANICAL 17 PLUMBING fl SIGN <br /> PROJECT ADDRESS � ^ <br /> �c��U n���rri.��� 1 Y FV2YP�- lJ.l'Pt `1g �� <br /> owr+ca anooness cm z�r rrwNe <br /> �ii y,�. a � 7tz�rxsrv�p.rc G;� ��7r �� �zo 3s�-o��� <br /> TENANT y MRILA�OFE55 CITY ZIP PHONE <br /> ARCHITECQRDESIGN�ER��_ MRILApDRE55 GIiY ZIP PMONE <br /> �/V l��l' <br /> GENERQ1CONTRIICTOR MRILADDRE55 Cli� ZIP PHONE STATEUCENSE• <br /> �� <br /> MECHAN/ICfQ� (C.ON'�TRACTO�R 7 M�ILqODRE55 Cltt ZIP PNONE STRTELICENSE� <br /> l`l IA.I �l�[ <br /> PWMBINGCO,NeTR1�CTqi MRIUOORESS Cltt IIP PNONE STATELICENSEx <br /> �W � <br /> CONTIUCT PRICE OF WORI ,// �J /_ <br /> �� � ����� � «' HEATING SYSTEM: ❑ GAS ELECTRIC ❑ <br /> OESCRIB A 5 UARE F TA OL �ONAC �N�{�NQNE NO. /j���� _ \ <br /> J �c r ��i <br /> �` - 0 ,�/r!�` 3�B -OC�/6 <br /> I HEREBY �ERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PqOPO5E0 USE OF BUILU�N� APPLICATION n�D KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> — E PROVISIONS OF Li.'.NS AND ORDINANCES GOVERNING TNIS TYPE 0= <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEFlEIN OR <br /> LF.GIILDESCR ONOFPROPERTY�SHOWNBEL ORATfACNMOCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or�BLOCK oF _. AUTHORITY TO ViOLATE OR CANCEI THE PROVISION OF ANY <br /> S� A�/7LTJ�// PERFORMANCE OF CONSTRUCTION.�TH TG 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 /> PARCELiA%I.D.NUMBER CONTRACTORS LAW 1 . RCW AND 296200 WAC. <br /> a �` /�/- /�S <br /> CONSTRUCTI LOI1N IENDER,A 55. EPHONE NUMBER X <br /> SIGNR URE D�TE <br /> � CITY BUSINE55 LICENSE NO. . <br /> PLUMBIIW MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE N0. TVPE OF FlIRURE OR ITEM FEE <br /> WATER CLOSET(TOIIET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS—B.T.U. M ; <br /> KITCHEN SINK 6 DISP � CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAV RANGE HOOD ; <br /> CIOTHES WASHER WATER HEATER (p � <br /> URINAL ' WOOD STOVE ~— <br /> �RINKINO FOUNTA�N � METAL FIREPLACE(WOOD OURNING) � <br /> FLOOR DRPIN � FIREPLACE INSERT(N/OOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE � <br /> � <br /> GAS P�PING ' <br /> � EXHAUSTFAN � <br /> � � <br /> � � <br /> � � <br /> _ SUB TOTAL S , SUB TOTAL S S i <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ TOTALFEE A � <br /> FOR OFFICE USE ONLY: �a , �� <br /> FRONT SETB�CN � qE�R SETBACK / SIOE SE�PC PUN CHECK N q FEE ��j RECEIPi NO. <br /> � �' <br /> use:oN� � wr�aFn vncnNi rtE FEES VALUATIO;1 FEE _ <br /> .r <br /> nves n No emioir�c 3op ���_� I,a�> <br /> HEIGHTUMITATION / NO.OFDWELIING SIZEOFOLOG/Tl — <br /> uwts Ol7 Sf �'wNoiNc �� ; !�D <br /> OCCUPANCY NO Oi5i0RIE5 OCCUPANTLOAD BASEMENT � <br /> GROUP MEC114NICAL /� i/�,1 <br /> -3 2- A nves � =' �. <br /> � <br /> FlRERLAFMREO'U REASON ADDITIONA�PLANCIIECR / J��J <br /> (� pTNER � <br /> FIRE SPNINKLER PFOU REASpN � <br /> � STRTE BUILDIN6 SURCHARGE f��,:� <br /> TVPEOFCORST PLANSAPPROVEDBY � <br /> CITV OF EVERETT run�ic wr;nKs ��-- <br /> LOCAL SALES <br /> - hI DATE 7 LS�4G TAX CODE IS 3105 TOTAI (//� � �J <br /> — _ 1 <br />